不同时机CRRT治疗对脓毒症患者炎症指标血流动力学及预后的影响

Effects of CRRT at Different Times on Inflammatory Indicators, Hemodynamics and Prognosis in Patients with Sepsis

目的:研究不同时机连续性肾脏替代治疗(CRRT)对脓毒症患者炎症指标、血流动力学及预后的影响。方法:回顾性分析医院2016年1月至2018年12月收治的54例脓毒症患者临床资料,根据患者行CRRT治疗时的病情将其分为单纯脓毒症组(n=27)与脓毒症休克组(n=27),观察两组治疗前后感染情况、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、炎症指标、血流动力学及预后。结果:脓毒症休克组患者治疗前白细胞(WBC)、降钙素原(PCT)及体温水平均显著高于脓毒症组(P<0.05),经治疗后,两组WBC、PCT及体温水平均较同组治疗前显著下降(P<0.05),且脓毒症休克组患者治疗后,WBC及PCT水平均显著高于脓毒症组(P<0.05);治疗前、治疗3d及7d后,两组患者APACHEⅡ评分均呈依次下降趋势,组内不同时间点均差异显著(P<0.05),脓毒症休克组患者治疗前、治疗3d及7d后APACHEⅡ评分均显著高于脓毒症组(P<0.05);治疗前,脓毒症休克组患者肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均显著高于脓毒症组(P<0.05),两组IL-6水平治疗前无显著性差异(P>0.05),治疗后,两组血清TNF-α、CRP及IL-6水平均较同组治疗前显著下降(P<0.05),脓毒症休克组患者治疗后TNF-α、CRP及IL-6水平均显著高于脓毒症组(P<0.05);两组治疗前心率(HR)、平均动脉压(MAP)及中心静脉压(CVP)水平无显著性差异(P>0.05),治疗后,脓毒症组HR水平较同组治疗前显著下降(P<0.05),MAP及CVP水平无显著性改变(P>0.05),治疗后脓毒症休克组患者HR水平较同组治疗前显著下降,MAP水平较同组治疗前显著上升(P<0.05),CVP水平无显著性改变(P>0.05),且脓毒症休克组患者治疗后HR水平水平显著高于脓毒症组,MAP水平显著低于脓毒症组(P<0.05),两组CVP水平无显著性差异(P>0.05);脓毒症组患者经CRRT治疗后,28d死亡率显著低于脓毒症休克组(P<0.05)。结论:CRRT能有效清除脓毒症及脓毒症休克患者机体炎症介质,维持血流动力学稳定,而早期进行CRRT干预,能有效改善脓毒症患者预后,延长其生存期。

Objective:To study the effects of different timing of continuous renal replacement therapy(CRRT)on inflammation markers,hemodynamics and prognosis in patients with sepsis.Methods:The clinical data of 54 patients with sepsis admitted to the hospital from January 2016 to December 2018 were retrospectively analyzed.The patients were divided into simple sepsis group(n=27)and septic shock group(n=27)according to the condition of patients with CRRT therapy.The infection status,acute physiology and chronic health evaluation II(APACHE II),inflammation markers,hemodynamics and prognosis were observed in the two groups before and after treatment.Results:The levels of white blood cells(WBC),procalcitonin(PCT)and body temperature in septic shock group before treatment were significantly higher than those in sepsis group(P<0.05).After treatment,the levels of WBC,PCT and body temperature in the two groups were significantly lower than those in the same group before treatment(P<0.05),and the levels of WBC and PCT in septic shock group after treatment were significantly higher than those in sepsis group(P<0.05).Before treatment and after 3d and 7d treatment,the APACHE II scores in the two groups showed a downward trend(P<0.05),and the APACHE II scores in septic shock group were significantly higher than those in sepsis group before treatment and after 3d and 7d of treatment(P<0.05).Before treatment,the levels of tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)in septic shock group were significantly higher than those in sepsis group(P<0.05),and there was no significant difference in the level of IL-6 between the two groups before treatment(P>0.05).After treatment,the levels of serum TNF-α,CRP and IL-6 in the two groups were significantly lower than those in the same group before treatment(P<0.05),and the levels of TNF-α,CRP and IL-6 in septic shock group after treatment were significantly higher than those in sepsis group(P<0.05).There were no significant differences in the heart rate(HR),mean arterial pressure(MAP)and central venous pressure(CVP)between the two groups before treatment(P>0.05).After treatment,the HR level in sepsis group was significantly lower than that in the same group before treatment(P<0.05),and there were no significant changes in the levels of MAP and CVP(P>0.05),and the HR level in septic shock group after treatment was significantly lower than that in the same group before treatment,and the MAP level was significantly higher than that in the same group before treatment(P<0.05),and there was no significant change in CVP level(P>0.05),and the HR level in septic shock group after treatment was significantly higher than that in sepsis group while the MAP level was significantly lower than that in sepsis group(P<0.05),and there was no significant difference in CVP level between the two groups(P>0.05).The 28d mortality rate in sepsis group after CRRT therapy was significantly lower than that in septic shock group(P<0.05).Conclusion:CRRT can effectively eliminate the inflammatory mediators and maintain hemodynamic stability in patients with sepsis and septic shock.Early CRRT intervention can effectively improve the prognosis and prolong the survival time of patients with sepsis.