连续性血液净化对重型颅脑损伤继发高钠血症患者短期预后的影响

Effect of continuous blood purification on short-term prognosis of patients with hypernatremia secondary to severe craniocerebral injury

目的探讨连续性血液净化(CBP)对重型颅脑损伤继发高钠血症患者短期预后的影响。方法纳入2022-03—2023-12攀枝花学院附属医院收治的98例重型颅脑损伤患者,采用随机数字表法分为实验组与对照组,各49例。对照组给予常规治疗,实验组给予CBP治疗。检测血钠、渗透压、急性生理与慢性健康评分、肝肾功能指标、炎症指标、血流动力学指标,观察2组预后。结果治疗后,实验组血钠、血浆渗透压、急性生理与慢性健康评分低于对照组(分别为145.41±3.26比159.23±4.05,265.34±16.52比291.03±18.41,14.26±4.25比18.33±5.18,P<0.05)。治疗后,实验组尿素氮、肌酐、丙氨酸氨基转移酶、天冬氨酸氨基转移酶低于对照组(分别为8.68±2.35比13.26±2.78,140.17±42.86比202.38±65.12,60.58±19.42比84.26±25.37,52.49±16.41比72.92±21.18,P<0.05)。治疗后,实验组IL-6、IL-1β、TNF-α低于对照组(分别为9.05±2.27比24.76±2.48,3.68±1.19比9.63±3.11,4.35±1.33比10.07±3.15,P<0.05)。治疗后,实验组平均动脉压高于对照组(92.88±5.62比72.45±6.57,P<0.05),实验组中心静脉压低于对照组(7.12±2.03比11.63±3.47,P<0.05)。实验组存活率为79.59%(39/49),对照组存活率为61.22%(30/49),2组存活率比较差异有统计学意义(χ^(2)=3.967,P=0.046)。结论CBP能够有效减轻重型颅脑损伤继发高钠血症患者血钠、血浆渗透压紊乱,改善患者肝肾功能、血流动力学,减轻炎症,且能够改善短期预后。

Objective To investigate the effect of continuous blood purification(CBP)on short-term prognosis of patients with hypernatremia secondary to severe craniocerebral injury.Methods 98 patients with severe traumatic brain injury admitted to the Affiliated Hospital of Panzhihua University from March 2022 to December 2023 were randomly divided into an experimental group and a control group,with 49 cases in each group,using a random number table method.The control group received routine treatment,and the experimental group received CBP treatment.Blood sodium,osmotic pressure,acute physiological and chronic health scores,liver and kidney function indexes,inflammatory indexes,and hemodynamic indexes were measured,and the prognosis of the two groups was observed.Results After treatment,Serum sodium,plasma osmotic pressure,acute physiological and chronic health scores in the experimental group were lower than those in the control group(145.41±3.26 vs 159.23±4.05,265.34±16.52 vs 291.03±18.41,14.26±4.25 vs 18.33±5.18,respectively,P<0.05).After treatment,urea nitrogen,creatinine,alanine aminotransferase,aspartate aminotransferase in experimental group were lower than those in control group(8.68±2.35 vs 13.26±2.78,140.17±42.86 vs 202.38±65.12,60.58±19.42 vs 84.26±25.37,52.49±16.41 vs 72.92±21.18,respectively,P<0.05).After treatment,interleukin-6,interleukin-1β,tumor necrosis factor-αin experimental group were lower than those in control group(9.05±2.27 vs 24.76±2.48,3.68±1.19 vs 9.63±3.11,4.35±1.33 vs 10.07±3.15,respectively,P<0.05).After treatment,the mean arterial pressure of the experimental group were higher than those of the control group(92.88±5.62 vs 72.45±6.57,P<0.05),and the central venous pressure in the experimental group was lower than that in the control group(7.12±2.03 vs 11.63±3.47,P<0.05).The survival rate of the experimental group was 79.59%(39/49),and that of the control group was 61.22%(30/49).There was a significant difference between the two groups(χ^(2)=3.967,P=0.046).Conclusion CBP can effectively reduce the disorder of blood sodium and plasma osmotic pressure in patients with hypernatremia secondary to severe craniocerebral injury,improve liver and kidney function,hemodynamics,reduce inflammation,and improve short-term prognosis.