连续肾脏替代疗法治疗不明原因发热合并多脏器功能障碍的近期临床价值

Short-term Clinical Value of Continuous Renal Replacement Therapy in the Treatment of Patients with Unexplained Fever and Multiple Organ Dysfunction Syndrome

目的 探讨连续肾脏替代疗法(continuous renal replacement therapy, CRRT)治疗不明原因发热合并多脏器功能障碍(multiple organdysfunction syndrome, MODS)的近期临床价值。方法 选取2015年5月—2018年5月我院收治的58例不明原因发热合并MODS,均行CRRT及常规治疗。观察治疗前(T0)、治疗后6 h(T1)、治疗后12 h(T2)、治疗后18 h(T3)、治疗后24 h(T4)、治疗后48 h(T5)及治疗后72 h(T6)炎性因子[白细胞介素-6(interleukin-6, IL-6)、白细胞介素-1β(interleukin-1β, IL-1β)、肿瘤坏死因子-ɑ(tumor necrosis factor -ɑ, TNF-ɑ)]、肝功能[丙氨酸转氨酶(alanine aminotransferase, ALT)、天冬氨酸转氨酶(aspartate transaminas, AST)]、肾功能[尿素氮(blood urea nitrogen, BUN)、肌酐(serum creatinine, SCr)、肌红蛋白(myoglobin, Mb)、肌酸激酶(creatinekinase, CK)]、血流动力学[心率、平均动脉压(mean artery pressure, MAP)]、体温和氧合指数水平及急性生理与慢性健康(acute physiology and chronic health evaluation, APACHE Ⅱ)评分,记录预后及不良反应发生情况。结果 与T0时比较,T1~T6时IL-6、T2~T6时IL-1β、T4~T6时TNF-ɑ、T3~T6时ALT、AST、BUN、SCr、Mb和CK水平均下降,T3~T6时心率和体温降低、MAP升高,T4~T6时氧和指数升高、APACHE Ⅱ评分降低,差异具有统计学意义( P <0.01)。本组经CRRT治疗后16例死亡,42例存活,存活率为72.41%,且治疗过程中均未出现血管通路不畅、空气栓塞及电解质失衡等严重不良反应。结论 CRRT治疗不明原因发热合并MODS具有一定的临床效果,能抑制炎性反应,改善血流动力学,保护肝肾功能,且无明显严重不良反应,是临床治疗不明原因发热合并MODS的适用方案之一。

Objective To determine the short-term clinical value of continuous renal replacement therapy (CRRT) in the treatment of patients with unexplained fever and multiple organ dysfunction syndrome (MODS). Methods A total of 58 patients with unexplained fever and MODS admitted to our hospital from May 2015 to May 2018 were selected for CRRT and conventional treatment. The inflammatory factors [interleukin-6 (IL-6), interleukin-1β(IL-1β), tumor necrosis factor-ɑ(TNF-ɑ)], liver function [alanine aminotransferase (ALT), aspartate transaminas (AST)], renal function [blood urea nitrogen (BUN), serum creatinine (SCr), myoglobin (Mb), creatinekinase (CK)], hemodynamics [heart rate (HR), mean arterial pressure (MAP)], body temperature, oxygenation index, and Acute Physiology and Chronic Health Evaluation ( APACHE) II score, before treatment (T0), at 6 h after treatment (T1), at 12 h after treatment (T2), at 18 h after treatment (T3), at 24 h after treatment (T4), at 48 h after treatment (T5), and at 72h after treatment (T6) were observed. Prognosis and the occurrence of adverse reactions were recorded. Results Compared with those at T0, IL-6 at T1-T6, IL-1β at T2-T6, and TNF-ɑ at T4-T6, and ALT, AST, BUN, SCr, Mb and CK at T3-T6 were decreased, and HR and body temperature at T3-T6 were decreased. In addition MAP was increased, oxygenation index was increased at T4-T6, and APACHE II score was decreased, suggesting significant difference ( P <0.01). In this group, 16 patients died after CRRT treatment, 42 patients survived, and the survival rate was 72.41%. There were no serious adverse reactions such as poor vascular access, air embolism and electrolyte imbalance during the treatment. Conclusion For patients with unexplained fever combined with MODS, CRRT has a certain clinical efficiency and has a certain inhibitory effect on the body's inflammatory response. It can improve the patients' hemodynamics and protect liver and kidney function. In addition, there is no obvious serious adverse reaction in CRRT treatment. Therefore, it is one of the applicable programs for clinical treatment of unexplained fever combined with MODS.