CRRT治疗剂量对脓毒症患者炎症反应及预后的影响

Effect of CRRT Dosage on Inflammatory Response and Prognosis in Sepsis Patients

目的:探讨连续性肾脏替代治疗(CRRT)治疗剂量对脓毒症患者炎症反应及预后的影响。方法:纳入2018年1月-2019年1月在笔者所在医院接受CRRT治疗的脓毒症患者80例,随机分成两组,各40例。高剂量组给予滤出液剂量≥35 ml/(kg·h)治疗,低剂量组给予滤出液量<35 ml/(kg·h)治疗,评估不同剂量的疗效。结果:治疗前两组TNF-α、IL-6、IL-8及IL-10比较差异无统计学意义(P>0.05),治疗后两组血清细胞因子水平均优于治疗前,且高剂量组TNF-α、IL-6、IL-8、IL-10均低于低剂量组,差异均有统计学意义(P<0.05)。高剂量组ICU住院时间、机械通气时间均短于低剂量组,差异均有统计学意义(P<0.05),两组APACHEⅡ评分比较差异无统计学意义(P>0.05)。高剂量组病死率为10.0%,低剂量组病死率为15.0%,差异无统计学意义(x^2=0.457,P=0.498)。结论:滤出液剂量≥35 ml/(kg·h)治疗剂量的CRRT治疗脓毒症有效、可行,值得临床推广。

Objective:To investigate the effect of continuous renal replacement therapy(CRRT)on inflammatory reaction and prognosis in patients with sepsis.Method:A total of 80 sepsis patients who received CRRT treatment in the author’s hospital from January 2018 to January 2019 were included,and were randomly divided into two groups,40 cases each.The high dose group was treated with filtration solution dose≥35 ml/(kg·h),and the low dose group was treated with filtration liquid dose less than 35 ml/(kg·h).The curative effect of different doses was evaluated.Result:There was no significant difference in TNF-α,IL-6,IL-8 and IL-10 between the two groups before treatment(P>0.05).After treatment,the levels of serum cytokines in the two groups were better than those before treatment,and the levels of TNF-αand IL-6,IL-8,IL-10 in the high dose group were lower than those in the low dose group,the differences were statistically significant(P<0.05).The hospitalization time and mechanical ventilation time of ICU in high dose group were shorter than those in low dose group,the differences were statistically significant(P<0.05).There was no significant difference between the two groups of APACHEⅡscores(P>0.05).The mortality of the high-dose group was 10.0%,the mortality of the low-dose group was 15.0%,there was no significant difference(x^2=0.457,P=0.498).Conclusion:CRRT with filtrate dose≥35 ml/(kg·h)is effective and feasible in the treatment of sepsis,and is worth popularizing in clinic.