CRRT治疗严重脓毒血症中的价值分析

Value of CRRT in the Treatment of Severe Sepsis

目的:评价连续性肾脏替代治疗(CRRT)在严重脓毒血症中的应用价值。方法:选取2016年1月~2018年1月于某院ICU治疗的行CRRT治疗的严重脓毒血症患者46例为观察组,同期常规治疗未选择CRRT的严重脓毒血症患者50例为对照组,动态监测并对比两组患者血流动力学、血清学指标及病死率。结果:治疗后,两组患者中心静脉压(CVP)、平均动脉压(MAP)以及中心静脉血氧饱和度(ScvO2)均较治疗前显著提高,且观察组显著高于对照组(P<0.05);治疗后,两组患者乳酸(Lac)、降钙素原(PCT)、血肌酐(Cr)、C反应蛋白(CRP)均显著降低,且观察组改善显著优于对照组(P<0.05);观察组30d病死率显著低于对照组,差别有统计学意义(P<0.05)。结论:在严重脓毒血症患者中采用CRRT治疗,能够维持血流动力学平衡,减少炎症介质释放、改善肾脏功能,降低病死率,值得在临床应用中进一步推广。

Objective: To evaluate the value of continuous renal replacement therapy(CRRT) in the treatment of severe sepsis. Methods: 46 patients with severe sepsis treated by CRRT in a hospital from January 2016 to January 2018 were selected as the observation group, and 50 cases of severe sepsis without CRRT were selected as the control group in the same period. The hemodynamics, serological indexes and mortality of the two groups were dynamically monitored and compared. Results: After treatment, the central venous pressure(CVP), mean arterial pressure(MAP) and central venous oxygen saturation(ScvO2) in the two groups were significantly higher than those before the treatment, and the observation group was significantly higher than the control group(P<0.05). After treatment, the lactic acid(Lac), calcitonin(PCT), serum creatinine(Cr) and C reactive protein(CRP) in the two groups were both significantly decreased, and the improvement of the observation group was significantly better than that of the control group(P<0.05). The mortality rate in the observation group was significantly lower than that in the control group on the 30 day(P<0.05). Conclusion: The use of CRRT in patients with severe sepsis can maintain the balance of hemodynamics, reduce the release of inflammatory mediators, improve renal function, and reduce the mortality rate. It is worthy of further popularization in clinical application.