摘要
目的评估脉冲式高容量血液滤过(PHVHF)联合血液灌流(HP)治疗脓毒性休克并发肾损伤患者的临床疗效。方法 2015年1月至2018年12月在江南大学附属医院明确诊断为脓毒性休克并发肾损伤住院患者36例,随机分为连续性血液滤过(CVVH)组(n=18)及PHVHF联合HP组(n=18)。对比两组病人治疗前后生命体征、生化指标、急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分以及去甲肾上腺素用量。采用ELISA方法检测治疗0h、2h、24h后血液及滤液白细胞介素(IL)-10,IL-6以及肿瘤坏死因子(TNF)-α的浓度。记录两组病人28 d病死率及90 d肾功能恢复情况。结果联合治疗组治疗后心率、WBC、C反应蛋白(CRP)、降钙素原(PCT)、APACHEⅡ评分、SOFA评分及去甲肾上腺素量下降优于CVVH组(P<0.05)。24 h后两组血液IL-10,IL-6以及TNF-α均有下降(P<0.05),联合治疗组效果更佳(P<0.05),HP治疗2h后即有明显下降(P<0.05),两组滤过液中均检测到以上炎症因子。联合治疗组28 d病死率为27.7%,有7例患者90 d内肾功能恢复,CVVH组病死率为38.8%,4例患者肾功能恢复。结论PHVHF联合HP可有效治疗脓毒性休克并发肾损伤。
Objective To evaluate the clinical effects of PHVHF combined with HP on septic shock with renal injury.Methods A total of 36 cases were involved in this study and were randomly divided into two groups: PHVHF & HP group(n=18)and CVVH group(n=18). Acute physiology and chronic health evaluation(APACHE)Ⅱ score,sequential organ failure assessment(SOFA)score,vital signs, biochemical changes and the dose of norepinephrine were compared before and after the treatment. The levels of IL-6,IL-10 and TNF-α in plasma and ultrafiltrate were assessed by ELISA before and after treatment for 0 h, 2 h and 24 h. The 28-day mortalities and the recovery of renal function within 90 days were also observed. Results After treatment,the decline of heart rate(HR),white blood cell(WBC),C-reactive protein( CRP),procalcitonin(PCT),APACHE II score,SOFA score and the dose of norepinephrine in combined group was better than that in CVVH group(P<0.05). After 24 h of treatment,the levels of IL-6,IL-10 and TNF-α decreased in both groups(P < 0.05),and the decrease was more significant in HP&PHVHF group(P<0.05). After 2 h of hemoperfison,there was a significant reduction in these inflammatory factors(P < 0.05). They were also detected in the filtrate of both groups. The mortality of combined therapy group was 27.7%,while in CVVH group it was 38.8%. Renal function of 7 patients in combined group recovered within 90 days,while 4 patients in CVVH group. Conclusion HP combined with PHVHF has a significant effect on septic shock with renal injury.
作者
储腊萍
俞娅芬
彭俊琼
周丽芳
魏宏义
胡敏红
CHU La-ping;YU Ya-fen;PENG Jun-qiong;ZHOU Li-fang;WEI Hong-yi;HU Min-hong(Deprmern of Nepbrology.,Affiliated Hospitnal of Jinngnan Uniersily,Wroui 214062.Chinn)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2020年第4期331-335,共5页
Chinese Journal of Practical Internal Medicine
基金
无锡市科教强卫医学青年人才项目(QNRCO48)。
关键词
血液灌流
脉冲式高容量血液滤过
连续性血液滤过
脓毒性休克肾损伤
炎症因子
hemoperfusion
pulse high-volume hemofiltration
continuous hemofiltration
septic shock with renal injury
inflammatory factor
