早期连续性肾脏替代治疗脓毒症并发急性肾损伤3期患者的疗效分析

Effects of early continuous renal replacement therapy on treatment of sepsis patients complicated with acute kidney injury in stage 3

目的 分析早期连续性肾脏替代治疗(Continuous renal replacement therapy,CRRT)对脓毒症合并急性肾损伤(Acute kidney injury,AKI)3期患者炎症因子及短期预后的影响,为合理制订重症感染性疾病的临床治疗方案提供依据.方法 选取2016年10月-2019年10月吉林大学第一医院收治的116例脓毒症合并AKI3期患者作为研究对象,根据随机数字表法分为研究组和对照组,每组58例.研究组患者于确诊AKI8h内行CRRT治疗,对照组患者于出现CRRT应用指征时开始行CRRT治疗.对两组患者的尿量恢复时间、CRRT治疗时间、 重症监护病房(Intensive care unit,ICU)治疗时间及CRRT治疗期间主要心血管不良事件(Major adverse cardiac events,MACE)发生率进行观察和对比.比较两组患者CRRT治疗前及治疗48 h血清肿瘤坏死因子-α(Tumor necrosis factor,TNF-α)、白细胞介素-6(Interleukin-6,IL-6)、IL-10水平.对两组患者7d、28 d、60 d的病死率进行分析.结果 研究组患者的尿量恢复时间、ICU治疗时间、MACE发生率与对照组比较,差异均有统计学意义(P<0.05);CRRT治疗48 h,两组患者的血清TNF-α、IL-6水平较治疗前下降,血清IL-10水平较治疗前上升,且研究组患者上述指标的改善幅度均优于对照组(P<0.05);两组患者7d、28 d、60 d的病死率及随访期内的估计平均生存期的差异均无统计学意义.结论 针对脓毒症合并AKI 3期患者早期开展CRRT治疗,能够显著降低炎症反应程度,下调促炎因子水平,提高疗效指标,降低心血管不良反应,但尚未观察到其具有改善患者短期预后的效果.

OBJECTIVE To observe the effect of early continuous renal replacement therapy(CRRT)on inflammatory factors and short-term prognosis of the sepsis patients complicated with acute kidney injury(AKI)in stage 3 so as to provide guidance for reasonable clinical treatment of severe infectious diseases.METHODS A total of 116 sepsis patients complicated with AKI 3 who were treated in No.1 Hospital of Jilin University from Oct 2016 to Oct 2019 were recruited as the study objects and randomly divided into the study group and the control group,with 58 cases in each group.The study group was treated with CRRT within 48 hours after the diagnosis of AKI,while the control group was given CRRT when the patients had the indications for CRRT.The time of recovery of urine volume,time of CRRT,time of treatment in intensive care unit(ICU)and incidence of major adverse cardiac events(MACE)during the CRRT were observed and compared between the two groups of patients.The levels of serum tumor necrosis factor(TNF-α),interleukin-6(IL-6)and IL-10 were compared between the two groups of patients before the CRRT and after the CRRT for 48 hours.The 7-day,28-day and 60-day mortality rates of the two groups of patients were observed.RESULTS There were significant differences in the time of recovery of urine volume,time of treatment in ICU and incidence of MACE between the study group and the control group(P<0.05).The levels of serum TNF-αand IL-6 of the two groups of patients were significantly lower after the CRRT for 48 hours than before the CRRT,the serum IL-10 level was significantly higher after the CRRT for 48 hours than before the CRRT,and the above indexes were improved more significantly in the study group than in the control group(P<0.05).There were no significant differences in the 7-day,28-day and 60-day mortality rates and estimated mean survival time during the follow-up between the two groups of patients.CONCLUSION The early CRRT can remarkably reduce the inflammatory response,downregulate the levels of proinflammatory factors,improve the indexes of curative effect and reduce the incidence of cardiovascular adverse reactions,however,the effect on improvement of short-term prognosis has not been observed.