不同剂量连续性肾脏替代治疗对重症肺炎合并脓毒症的应用效果分析

Effects of different doses of continuous renal replacement therapy on severe pneumonia complicated with sepsis

目的探讨不同剂量连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对重症肺炎合并脓毒症的应用效果。方法选取2017年1月至2019年1月新疆医科大学第一附属医院收治的66例重症肺炎合并脓毒症患者为研究对象。采用随机数字表法将入选患者分为低剂量组和高剂量组,每组各33例,两组患者在常规治疗基础上分别接受低剂量[50 ml/(kg•h)]和高剂量[100 ml/(kg•h)]置换液的CRRT。比较两组患者治疗前和治疗后7 d血清炎性因子、外周血免疫功能指标水平、病情严重程度和28 d转归情况。结果两组患者治疗后7 d血清高敏C反应蛋白(high-sensitivity C reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、血清淀粉样物质A(serum amyloid A,SAA)水平、多形核中性粒细胞(polymorphonuclear neutrophil,PMN)百分比、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分和急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分均显著低于本组治疗前(均P<0.05),CD4+T细胞/CD8+T细胞比值、PMN吞噬率、PMN吞噬指数均显著高于本组治疗前(均P<0.05);高剂量组患者治疗后7 d hs-CRP、TNF-α、SAA水平、PMN百分比、SOFA评分和APACHEⅡ评分均显著低于低剂量组(均P<0.05),CD4+T细胞/CD8+T细胞比值、PMN吞噬率、PMN吞噬指数均显著高于低剂量组(均P<0.05)。两组患者28 d病死率比较差异无统计学意义(P>0.05)。结论与低剂量[50 ml/(kg•h)]CRRT相比,高剂量[100 ml/(kg•h)]CRRT能显著减轻重症肺炎合并脓毒症患者的炎性反应,提高细胞免疫功能和PMN吞噬功能,缓解病情。

Objective To investigate the effect of different doses of continuous renal replacement therapy(CRRT)on severe pneumonia complicated with sepsis.Method Sixty-six patients with severe pneumonia complicated with sepsis from January 2017 to January 2019 in the First Affiliated Hospital of Xinjiang Medical University were enrolled for the study.Patient were divided into lowdose group(n=33)and high-dose group(n=33)according to the random number table method.On the basis of routine treatment,low-dose[50 ml/(kg•h)]and high-dose[100 ml/(kg•h)]replacement solution of CRRT were given respectively.The indexes of serum inflammation and peripheral blood immune function,severity and 28-day outcomes were compared between two groups before and 7 days after treatment.Result 7 days after treatment,the serum high-sensitivity C reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),serum amyloid A(SAA)levels,polymorphonuclear neutrophil(PMN)percentage,sequential organ failure assessment(SOFA)scores and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores of the two groups were significantly lower than those before treatment(all P<0.05),CD4+T cell/CD8+T cell ratios,PMN phagocytosis rates and PMN phagocytosis indexes were significantly higher than those before treatment(all P<0.05).The levels of hs-CRP,TNF-α,SAA,PMN percentage,SOFA score and APACHEⅡscore after treatment in high-dose group were significantly lower than those in low-dose group(all P<0.05),while CD4+T cell/CD8+T cell ratio,PMN phagocytosis rate and PMN phagocytosis index were significantly higher than those in low-dose group(all P<0.05).There was no significant difference in the 28-day mortality between the two groups(P>0.05).Conclusion Compared with low-dose[50 ml/(kg•h)]CRRT,high-dose[100 ml/(kg•h)]CRRT can significantly reduce the inflammatory reaction,improve the cellular immune function and PMN phagocytosis,and alleviate the disease.