早期连续肾脏替代疗法干预在腹源性脓毒症患者中的应用效果及对免疫功能的影响

Application of early CRRT intervention in patients with abdominal sepsis and its effect on immune regulation

目的:探究早期连续肾脏替代疗法(CRRT)干预在腹源性脓毒症患者中的应用及其对患者免疫调节功能的影响。方法:选取120例腹源性脓毒症患者为研究对象,随机分为对照组与观察组各60例。对照组采取常规治疗,观察组在对照组基础上给予CRRT治疗。比较两组临床疗效、肾功能指标[血肌酐(Scr)、尿素氮(BUN)]、炎性因子[降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、免疫因子水平[单核细胞-人类白细胞抗原(mHLA-DR)、T淋巴细胞亚群(CD4^(+)/CD8^(+))]、生理状况评估[急性生理学与慢行健康状况评分系统(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分]及不良反应。结果:观察组患者临床总有效率明显高于对照组,差异有统计学意义(P<0.05)。观察组Scr及BUN指标均低于对照组,差异有统计学意义(P<0.05)。观察组PCT、TNF-α及CRP水平均低于对照组,mHLA-DR及CD4^(+)/CD8^(+)免疫因子指标高于对照组,差异有统计学意义(P<0.05)。观察组APACHEⅡ及SOFA评分均低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率显著低于对照组,但差异无统计学意义(P>0.05)。结论:给予腹源性脓毒症患者早期CRRT干预,可显著改善患者的炎性反应,有助于调节患者的免疫功能,促进肾功能恢复,且安全性较高。

Objective To explore the application of early continuous renal replacement therapy(CRRT)intervention in patients with abdominal sepsis and its impact on the immune regulatory function of patients.Method 120 patients with abdominal sepsis were selected as the research subjects,they were divided into control group and observation group according to the random number table,60 patients in each group.The control group received routine treatment,while the observation group received CRRT treatment on the basis of the control group.Compare the clinical efficacy,renal function indicators[blood creatinine(Scr),urea nitrogen(BUN)],inflammatory factors[procalcitonin(PCT),tumor necrosis factor-α(TNF-α)、Hypersensitivity C-reactive protein(hs CRP)],immune factor level[monocyte human leukocyte antigen(mHLA-DR),T-lymphocyte subsets(CD4^(+)/CD8^(+))],physiological status assessment[APACHE II score,sequential organ failure assessment(SOFA)score]and adverse reactions.Results The total clinical effective rate in the observation group was significantly higher than that in the control group,with statistical significance(P<0.05).The indexes of Scr and BUN in the observation group were lower than those in the control group,with statistical significance(P<0.05).The levels of PCT,TNF-αand CRP in observation group was lower than those in the control group,the levels of mHLA-DR and CD4^(+)/CD8^(+)immune factors in the control group were significantly higher than those in the control group(P<0.05).The APACHE II and SOFA scores in the observation group were lower than those in the control group,with statistical significance(P<0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group,but there was no statistical significance between the two groups(P>0.05).Conclusion Early CRRT intervention for patients with abdominal sepsis can significantly improve the inflammatory reaction of patients,help regulate the immune function of patients,promote the recovery of renal function,and has high safety,which is worthy of clinical promotion.