血液净化不同滤器治疗脓毒症所致急性肾损伤对患者肾功能和血清炎症因子水平及预后的影响

Effects of different blood purification filters on renal function,serum inflammatory factors and prognosis in patients with acute renal injury caused by sepsis

目的探讨血液净化不同滤器治疗脓毒症所致急性肾损伤(AKI)对患者肾功能和炎症因子水平及预后的影响。方法选取重症监护病房(ICU)收治的120例脓毒症所致AKI患者作为研究对象,均接受连续肾脏替代治疗(CRRT治疗),依据采用的过滤器不同分为观察组和对照组,每组各60例。观察组采用oXiris滤器,对照组采用M150滤器。比较2组患者疗效指标,包括尿量恢复时间、ICU治疗时间及器官支持时间;比较2组患者治疗前后肾功能指标,包括血清尿素氮(BUN)、血清肌酐(Scr)、肾小球滤过率(GFR);比较2组患者治疗前后序贯器官衰竭评分(SOFA)、急性生理学及慢性健康状况评分(APACHEⅡ);比较2组患者治疗前后血清炎症因子,包括血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平;比较2组患者随访28 d生存情况。结果观察组患者尿量恢复时间、ICU治疗时间及器官支持时间均少于对照组,差异有统计学意义(P<0.05)。2组患者治疗前后肾功能各项指标比较,差异无统计学意义(P>0.05);2组患者治疗后Scr、BUN均低于同组治疗前,GFR则高于同组治疗前,差异有统计学意义(P<0.05)。2组患者治疗后SOFA、APACHEⅡ评分均低于同组治疗前,差异有统计学意义(P<0.05);观察组治疗后SOFA、APACHEⅡ评分显著低于对照组治疗后,差异有统计学意义(P<0.05)。2组患者治疗前TNF-α、IL-6、CRP水平比较,差异无统计学意义(P>0.05);2组患者治疗后TNF-α、IL-6、CRP水平均低于同组治疗前,差异有统计学意义(P<0.05)。2组患者治疗后均行28 d随访,期间观察组失访2例,死亡3例(5.17%),存活55例(94.83%);对照组失访1例,死亡5例(8.47%),存活54例(91.53%)。Kaplan-Meier生存分析显示2组存活率无明显差异(P<0.05)。结论采用CRRT时oXiris滤器与M150滤器均能有效改善脓毒症所致AKI患者肾脏功能,降低炎症因子水平,但oXiris滤器在改善SOFA、APACHEⅡ评分方面优于M150滤器。

Objective To investigate the effects of different blood purification filters on renal function,inflammatory factor levels and prognosis of patients with acute renal in patients with AKI reduced by sepsis.Methods 120 patients with AKI reduced by sepsis admitted to the intensive care unit(ICU)of our hospital were selected as the study objects,who were treated with continuous renal replacement therapy(CRRT).They were divided into observation group and control group according to the filter used,with 60 patients in each group.The oXiris filter was used in the observation group and M150 filter was used in the control group.The curative effect indexes of the two groups were compared,including urine volume recovery time,ICU treatment time and organ support time,The renal function indexes serum urea nitrogen(BUN),serum creatinine(Scr)and glomerular filtration rate(GFR)were compared between the two groups before and after treatment.The scores of sequential organ failure score(SOFA),acute physiology and chronic health status scoring system(APACHEⅡ)were compared between the two groups before and after treatment.The serum inflammatory factors(TNF-α,IL-6 and(CRP)were compared between the two groups before and after treatment.The survival of the two groups after 28 days of follow-up was compared.Results The recovery time of urine volume,ICU treatment time and organ support time in the observation group were significantly shorter than those in the control group(P<0.05).There was no significant difference in renal function between the two groups before and after treatment(P>0.05).After treatment,Scr and BUN of the two groups were lower than those of the same group before treatment,while GFR was higher than that of the same group before treatment,the difference was statistically significant(P<0.05).The scores of SOFA and APACHEⅡin the two groups after treatment were lower than those in the same group before treatment,and the difference was statistically significant(P<0.05).After treatment,the scores of SOFA and APACHEⅡin the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in the levels of TNF-α,IL-6 and CRP between two groups before treatment(P>0.05).The levels of TNF-α,IL-6 and CRP in the two groups after treatment were lower than those in the same group before treatment,and the difference was statistically significant(P<0.05).The patients in both groups were followed up for 28 days after treatment.During this period,2 cases in the observation group were lost,3 cases died(5.17%),and 55 cases survived(94.83%).In the control group,one case lost follow-up,five cases died(8.47%),and 54 cases survived(91.53%).Kaplan Meier survival analysis showed that there was no significant difference in survival rate between the two groups(P<0.05).Conclusion When using CRRT,Both OXiris filter and M150 filter can effectively improve renal function and reduce the level of inflammatory factors in patients with AKI reduced by sepsis,but oXiris filter is better than M150 filter in improving sofa and APACHEⅡscores.