连续性肾脏替代治疗应用时机对脓毒性休克集束化治疗患者疗效及预后的影响

Impact of timing of continuous renal replacement therapy on the efficacy and prognosis of patients with septic shock undergoing bundle therapy

目的探讨连续性肾脏替代治疗(CRRT)应用时机对脓毒性休克集束化治疗患者疗效及预后的影响。方法选取84例脓毒性休克患者作为研究对象,均接受集束化治疗。根据CRRT应用时机的不同,将患者分为早期CRRT组和晚期CRRT组,每组42例。比较2组患者治疗后的临床数据(心率、体温恢复正常时间、ICU住院时间)和治疗前后的感染情况[C反应蛋白(CRP)、降钙素原(PCT)]及免疫功能(CD4^(+)、CD8^(+)、CD14^(+))、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,并随访2组患者的28 d生存情况。结果早期CRRT组患者的心率低于晚期CRRT组,体温恢复正常时间、ICU住院时间均短于晚期CRRT组,差异有统计学意义(P<0.05)。治疗后,2组CRP、PCT水平均低于治疗前,且早期CRRT组低于晚期CRRT组,差异有统计学意义(P<0.05)。治疗后,2组CD8^(+)水平均低于治疗前,且早期CRRT组低于晚期CRRT组,差异有统计学意义(P<0.05);治疗后,2组CD4^(+)、CD14^(+)水平均高于治疗前,且早期CRRT组高于晚期CRRT组,差异有统计学意义(P<0.05)。治疗后,2组APACHEⅡ评分均低于治疗前,且早期CRRT组低于晚期CRRT组,差异有统计学意义(P<0.05)。随访结果显示,早期CRRT组28 d累积生存率为83.33%(35/42),高于晚期CRRT组的64.29%(27/42),差异有统计学意义(P<0.05)。结论对于脓毒性休克集束化治疗患者而言,早期应用CRRT的临床效果优于晚期应用,且有助于改善患者的预后。

Objective To investigate the impact of the timing of continuous renal replacement therapy(CRRT)on the efficacy and prognosis of patients with septic shock undergoing bundle therapy.Methods A total of 84 patients with septic shock who underwent bundle therapy were enrolled,receiving bundle therapy.Based on the timing of CRRT,the patients were divided into early CRRT group and late CRRT group,with 42 patients in each group.Clinical data(heart rate,time to normalization of body temperature,ICU length of stay)and infection status[C-reactive protein(CRP),procalcitonin(PCT)]and immune function(CD4^(+),CD8^(+),CD14^(+)),as well as the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores before and after treatment were compared between the two groups.The 28-day survival of patients in both groups was also followed up.Results The heart rate in the early CRRT group was lower than that in the late CRRT group,and the time to normalization of body temperature and ICU length of stay were shorter in the early CRRT group compared with the late CRRT group(P<0.05).After treatment,the levels of CRP and PCT in both groups were lower than those before treatment,and their levels in the early CRRT group were lower than those in the late CRRT group(P<0.05).After treatment,the levels of CD8^(+)in both groups were lower than those before treatment,and the early CRRT group had lower level than that in the late CRRT group(P<0.05);after treatment,the levels of CD4^(+)and CD14^(+)in both groups were higher than those before treatment,and their levels in the early CRRT group were higher than those in the late CRRT group(P<0.05).After treatment,the APACHEⅡscores of both groups were lower than those before treatment,and the early CRRT group had lower APACHEⅡscore than that in the late CRRT group(P<0.05).The follow-up results showed that the 28-day cumulative survival rate was 83.33%(35/42)in the early CRRT group,which was higher than 64.29%(27/42)in the late CRRT group(P<0.05).Conclusion For patients with septic shock undergoing bundle therapy,early application of CRRT is superior to late application in clinical efficacy,and contributes to improving the prognosis of patients.