早期积极液体复苏在脓毒性休克合并急性肾损伤中的应用研究

Study of early active fluid resuscitation in septic shock with acute renal injury

目的比较早期控制性液体复苏与快速性液体复苏策略在脓毒性休克合并急性肾损伤中的应用效果。方法连续选择2017年10月-2018年10月入本院诊断脓毒性休克合并急性肾损伤患者共80例,随机将其分为对照组和观察组各40例,对照组采用快速性液体复苏,观察组采用控制性液体复苏。对比2组早期复苏成功率和并发症,检测复苏前后6 h、12 h、24 h和72 h血清中性粒细胞载脂蛋白(HNL)、软骨糖蛋白39(YKL-40)和膜联蛋白A1水平。结果观察组复苏成功率高于对照组,并发症发生率降低,差异有统计学意义(P<0.05)。观察组复苏后6 h、12 h、24 h和72 h血清HNL、YKL-40和膜联蛋白A1水平均明显低于对照组,差异有统计学意义(P<0.05)。结论脓毒性休克合并急性肾损伤的早期救治中宜采用控制性液体复苏策略,对改善复苏效果,减轻机体炎症反应具有重要意义。

Objective To compare the clinical effect of early controlled or quick fluid resuscitation strategies for patients with septic shock and acute renal injury. Methods A total of 80 consecutives were enrolled in the study from October 2017 to October 2018 and randomly divided into control and observation groups,with 40 cases in each group;rapid fluid resuscitation was used in the control group and controlled fluid resuscitation was used in the observation group. Serum neutrophils apolipoprotein( HNL),chondroglycoprotein 39( YKL-40) and memectin A1 levels were detected at 6 h,12 h,24 h and 72 h before and after resuscitation. Results The success rate of resuscitation in the observation group was higher than that in the control group,and the incidence of complications was reduced,with the differences statistically significant( P < 0. 05). The serum levels of HNL,YKL-40 and memectin A1 in the observation group were significantly lower than those in the control group at 6 h,12 h,24 h and 72 h after resuscitation,and the differences were statistically significant( P < 0. 05). Conclusion The early treatment of septic shock with acute kidney injury should adopt the strategy of controlled fluid resuscitation,which is of great significance in improving the resuscitation effect and reducing the inflammatory response.