连续血液滤过治疗肿瘤术后合并肾功能衰竭的效果及对肾功能与炎性因子的影响

Efficacy of continuous hemofiltration for postoperative renal failure and the effect on the renal function and the level of inflammatory factors

目的探讨连续血液滤过治疗肿瘤术后合并肾功能衰竭患者的临床效果及对肾功能和炎性因子水平的影响。方法选取2015年1月至2016年12月间青岛市中心医院收治的64例肿瘤术后合并肾功能衰竭患者,进行连续血液滤过治疗,比较治疗前后患者尿素氮、血肌酐、血钠和血钾等肾功能指标及白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和白细胞介素10(IL-10)等炎性因子水平。结果治疗后,患者尿素氮、血肌酐和血钾水平较治疗前均下降,差异均有统计学意义(均P<0.05),血钠水平与治疗前比较无明显差异,差异无统计学意义(P>0.05)。治疗后,患者IL-6、TNF-α、CRP及IL-10水平较治疗前均下降,血氧分压和pH值较治疗前均上升,差异均有统计学意义(均P<0.05);二氧化碳分压水平与治疗前比较无明显差异,差异无统计学意义(P>0.05)。结论连续血液滤过治疗肿瘤术后合并肾功能衰竭患者具有良好的应用效果,可改善肾功能和呼吸功能,降低炎性因子水平,缓解炎性反应,维持机体内水、电解质和酸碱平衡,可在临床广泛推广。

Objective To explore the clinical efficacy of continuous hemofiltration for postoperative renal failure in patients with tumors and its effect on renal function and inflammatory factors. Methods From January 2015 to December 2016,64 patients with tumors complicated with renal failure after surgery at Qingdao Central Hospital were selected. These patients were treated with continuous hemofiltration. Renal function indexes including urea nitrogen,serum creatinine,serum sodium,serum potassium and the level of inflammatory cytokines including interleukin 6（IL-6）,tumor necrosis factor（TNF-alpha）,C reactive protein（CRP）,interleukin 10（IL-10） were compared before and after the treatment. Results Urea nitrogen,serum creatinine and serum potassium levels decreased significantly after the treatment（all P〈0. 05）,and there was no significant difference in serum sodium level compared with before the treatment（P〈0. 05）. Compared with before the treatment,IL-6,TNF-alpha,CRP and IL-10 levels significantly decreased and Pa O2 and pH significantly increased after the treatment（all P〉0. 05）. There was no significant differences in the level of Pa CO2 after the treatment compared with before the treatment（P〉0. 05）.Conclusion Continuous hemofiltration shows good efficacy in the treatment of postoperative renal failure in patients with tumors which not only can effectively improve renal and respiratory function,reduce the level of inflammatory factors,alleviate the inflammatory reaction,but also can maintain the body of water,electrolyte and acid-base balance. It can be popularized and applied widely in clinical practice.