连续性肾脏替代治疗对脓毒症合并急性肾损伤的效果

Eeffect of Continuous Renal Replacement Therapy in Patients with Sepsis Complicated with Acute Kidney Injury

目的:探究连续性肾脏替代治疗对脓毒症合并急性肾损伤的效果。方法:选择2019年6月—2022年6月佛山市南海区第四人民医院收治的80例脓毒症合并急性肾损伤患者。根据随机数表法分为对照组和观察组,各40例。对照组进行常规尿毒症治疗,观察组则进行连续性肾脏替代治疗。比较两组的ICU住院时间、ICU住院费用、28 d死亡率,以及治疗前后的平均动脉压、心率、尿量、血气分析结果 [酸碱度(pH)及动脉血氧分压(PaO_(2))]、肾功能指标[血肌酐(Scr)及血尿素氮(BUN)]、促炎因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)]及抗炎因子[白细胞介素-4(IL-4)、白细胞介素-10(IL-10)及转化生长因子β_(1)(TGF-β_(1))]水平。结果:观察组ICU住院时间显著短于对照组,ICU住院费用显著少于对照组,28 d死亡率显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组平均动脉压、心率及尿量比较,差异无统计学意义(P>0.05);治疗24 h及48 h后,观察组的平均动脉压及尿量显著高于对照组,心率则显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组血气分析结果比较,差异无统计学意义(P>0.05);治疗24 h及48 h后,观察组的p H、PaO_(2)显著高于对照组,差异有统计学意义(P<0.05)。治疗前,两组肾功能指标比较,差异无统计学意义(P>0.05);治疗24 h及48 h后,观察组Scr、BUN显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组促炎因子比较,差异无统计学意义(P>0.05),治疗24 h及48 h后,观察组IL-1β、IL-6、IL-8、TNF-α均显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组抗炎因子比较,差异无统计学意义(P>0.05),治疗24 h及48 h后,观察组IL-4、IL-10及TGF-β_(1)则显著低于对照组,差异有统计学意义(P<0.05)。结论:连续性肾脏替代治疗对脓毒症合并急性肾损伤的效果较好,可显著改善患者的肾功能,控制炎症反应。

Objective:To explore the effect of continuous renal replacement therapy on sepsis complicated with acute kidney injury.Method:A total of 80 patients with sepsis complicated with acute kidney injury were selected from June 2019 to June 2022 in the Fourth People's Hospital of Foshan Nanhai District.They were divided into control group and observation group according to random number table method,with 40 cases in each group.The control group received routine uremia treatment,and the observation group received continuous renal replacement therapy.The length of ICU stay,ICU hospitalization cost and 28 d mortality of the two groups were compared;and mean arterial pressure,heart rate,urine volume,blood gas analysis results[power of hydrogen(pH)and partial pressure of arterial oxygen(PaO_(2))],renal function indicators[serum creatinine(Scr)and blood urea nitrogen(BUN)],pro-inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]and anti-inflammatory factors[interleukin-4(IL-4),interleukin-10(IL-10)and transforming growth factorβ_(1)(TGF-β_(1))]levels before and after treatment were compared.Result:The length of ICU stay in the observation group was significantly shorter than that in the control group,the cost of ICU hospitalization was significantly less than that in the control group,and the 28 d mortality was significantly lower than that in the control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in mean arterial pressure,heart rate and urine volume between the two groups(P>0.05).After 24 h and 48 h treatment,the mean arterial pressure and urine volume of the observation group were significantly higher than those of the control group,while the heart rate was significantly lower than that of the control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in blood gas analysis between the two groups(P>0.05).After 24 h and 48 h treatment,pH and PaO_(2) in observation group were significantly higher than those in control group,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in renal function indexes between the two groups(P>0.05).After 24 h and 48 h treatment,Scr and BUN in observation group were significantly lower than those in control group,and the differences were statistically significant(P<0.05).Before treatment,there were no statistically significant differences in pro-inflammatory factors between the two groups(P>0.05).After 24 h and 48 h treatment,IL-1β,IL-6,IL-8 and TNF-αin the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Before treatment,there were no statistically significant differences in anti-inflammatory factors between the two groups(P>0.05).After 24 h and 48 h treatment,IL-4,IL-10 and TGF-β_(1) in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Conclusion:Continuous renal replacement therapy has a good effect on sepsis complicated with acute kidney injury,and significantly improves renal function and controls inflammation.