杂合肾脏替代治疗对脓毒症合并急性肾损伤患者生命体征及感染指标的影响

Effects of hybrid renal replacement therapy on vital signs and infection indexes in patients with sepsis complicated with acute kidney injury

目的1.探讨杂合肾脏替代治疗(Hybrid Renal Replacement Therapy,HRRT)能否改善脓毒症合并急性肾损伤(Acute Kidney Injury,AKI)患者平均动脉压、心率及体温情况;2.探讨杂合肾脏替代治疗能否降低脓毒症合并AKI患者血浆降钙素原、白细胞、血乳酸水平。方法将2015-2017年收治的108例脓毒症合并AKI患者按随机数表法分为对照组和观察组。对照组给予脓毒症除血液净化外的常规治疗,观察组在对照组治疗的基础上加用HRRT治疗。比较两组治疗前后48 h的平均动脉压、心率、体温情况及血浆降钙素原、白细胞、血乳酸水平。结果治疗48 h后观察组心率、体温改善虽好于对照组,但差异不具有显著性(P>0.05),但平均动脉压的改善明显优于对照组,且差异具有显著性(P<0.05)。治疗48 h后观察组白细胞下降水平差异不具有显著性(P>0.05),但血乳酸及血浆降钙素原下降水平明显好于对照组,且差异具有显著性(P<0.05)。结论1.杂合肾脏替代治疗有助于稳定脓毒症合并AKI患者的平均动脉压;2.杂合肾脏替代治疗可以降低脓毒症合并AKI患者血乳酸及血浆降钙素原水平。

Objective 1.To explore whether the Hybrid Renal Replacement Therapy(HRRT)can improve the heart rate,mean artery pressure,and body temperature in patients with sepsis complicated with Acute Kidney Injury(AKI).2.To investigate whether HRRT can reduce plasma procalcitonin,white blood cells and blood lactic acid levels in AKI patients with sepsis.Methods A total of 108 AKI patients with sepsis admitted from October 2015 to September 2017 were selected and randomly divided into a control group and an observation group according to treatment regimens.The control group was given conventional treatment,while the observation group was given HRRT adding to the conventional treatment.The heart rate,mean artery pressure,body temperature,plasma procalcitonin,white blood cells and blood lactic acid levels were compared between the observation group and the control group 48 hours before and after treatment.Results After 48 hours of treatment,although the improvement in body temperature and heart rate of the observation group was better than that of the control group,the difference was not statistically significant(P>0.05).The improvement in mean arterial pressure was significantly better than that of the control group,and the difference was statistically significant(P<0.05).After 48 hours of treatment,the decrease of white blood cells in the observation group was not statistically significant(P>0.05),but the decrease of blood lactate and plasma procalcitonin were significantly better than those of the control group with statistical significance(P<0.05).Conclusion 1.HRRT can stabilize the mean arterial pressure in AKI patients with sepsis;2.HRRT can reduce the serum lactic acid and plasma procalcitonin levels in AKI patients with sepsis.