CRRT对脓毒症急性肾损伤患者容量状态及NT-proBNP水平的影响
|
摘要
目的:探讨应用CRRT(连续肾脏代替)对脓毒症急性肾损伤患者进行治疗的效果以及其对患者容量状态和NT-proBNP的影响。方法:选取本院2017年2月-2018年2月收治的脓毒症急性肾损伤患者98例,将其按照随机数字表法分为对照组和研究组各49例,对照组患者采用常规治疗,研究组患者采用CRRT治疗,观察并比较两组患者容量状态、NT-proBNP水平、体征指标、生化指标以及28 d存活率。结果:研究组患者容量明显低于对照组患者(P<0.05)。治疗前,两组患者NT-proBNP水平比较差异无统计学意义(P>0.05);治疗后,研究组患者明显低于对照组(P<0.05)。治疗前,两组患者体征指标比较差异均无统计学意义(P>0.05);治疗后,两组患者SpO_2、MAP、SBP、DBP比较,差异均无统计学意义(P>0.05),研究组患者尿量明显多于对照组(P<0.05)。治疗前,两组患者生化指标比较,差异均无统计学意义(P>0.05);治疗后,研究组患者BUN、N、Scr、hs-CRP、PLT、WBC明显低于对照组(P<0.05),两组Hb水平比较差异无统计学意义(P>0.05)。研究组患者28 d存活率93.9%明显高于对照组69.4%,两组比较差异有统计学有意义(P<0.05)。结论:应用CRRT对脓毒症急性肾损伤患者进行治疗的效果更佳,能够使患者的容量状态及NT-proBNP水平得到有效改善,值得推广及应用。
Objective:To investigate the effect of CRRT(continuous kidney replacement)on the treatment of patients with acute kidney injury in sepsis and the effect on the patients' volume state and NT-probnp.Method:98 patients with acute kidney injury in our hospital February 2017 to February 2018 were selected,in accordance with the random number table method,they were divided into control group and the treatment group,49 cases in each group.The control group was given routine treatment,the treatment group was given CRRT.The capacity status,NT-proBNP level,signs,biochemical indicators and 28 d survival rate of two groups were observed and compared.Result:The volume of the study group was significantly lower than that of the control group(P<0.05).Before treatment,there was no significant difference in NT-proBNP level between the two groups(P>0.05);after treatment,the level of NT-proBNP in the study group was significantly lower than that in the control group(P<0.05).Before treatment,there was no significant difference in the signs between the two groups(P>0.05);after treatment,there was no significant difference in SpO_2,MAP,SBP and DBP between the two groups(P>0.05),the urine volume of the study group was significantly higher than that of the control group(P<0.05).Before treatment,there was no significant difference in biochemical indexes between the two groups(P>0.05).After treatment,the levels of BUN,N,Scr,hs-CRP,PLT and WBC in the study group were significantly lower than those in the control group(P<0.05),and there was no significant difference in Hb level between the two groups(P>0.05).The 28-day survival rate of the study group was 93.9%,which was significantly higher than that of the control group 69.4%(P<0.05).Conclusion:The application of CRRT for sepsis acute kidney injury patients for better treatment,can make the patients' volume state and NT-proBNP level has been effectively improved,it is worth promoting and application.
Objective:To investigate the effect of CRRT(continuous kidney replacement)on the treatment of patients with acute kidney injury in sepsis and the effect on the patients' volume state and NT-probnp.Method:98 patients with acute kidney injury in our hospital February 2017 to February 2018 were selected,in accordance with the random number table method,they were divided into control group and the treatment group,49 cases in each group.The control group was given routine treatment,the treatment group was given CRRT.The capacity status,NT-proBNP level,signs,biochemical indicators and 28 d survival rate of two groups were observed and compared.Result:The volume of the study group was significantly lower than that of the control group(P<0.05).Before treatment,there was no significant difference in NT-proBNP level between the two groups(P>0.05);after treatment,the level of NT-proBNP in the study group was significantly lower than that in the control group(P<0.05).Before treatment,there was no significant difference in the signs between the two groups(P>0.05);after treatment,there was no significant difference in SpO_2,MAP,SBP and DBP between the two groups(P>0.05),the urine volume of the study group was significantly higher than that of the control group(P<0.05).Before treatment,there was no significant difference in biochemical indexes between the two groups(P>0.05).After treatment,the levels of BUN,N,Scr,hs-CRP,PLT and WBC in the study group were significantly lower than those in the control group(P<0.05),and there was no significant difference in Hb level between the two groups(P>0.05).The 28-day survival rate of the study group was 93.9%,which was significantly higher than that of the control group 69.4%(P<0.05).Conclusion:The application of CRRT for sepsis acute kidney injury patients for better treatment,can make the patients' volume state and NT-proBNP level has been effectively improved,it is worth promoting and application.
引文
[1]陈玉红,郑明,李斌,等.不同连续性肾脏替代治疗模式及其剂量对脓毒症合并急性肾损伤患者溶质清除效果的研究[J].中国全科医学,2016,19(18):112-113.
[2]胡辰.脓毒血症急性肾损伤的病理机制研究进展[J].国际泌尿系统杂志,2011,31(5):686-689.
[3]李萍珠,徐炜新.脓毒血症并发急性肾损伤早期诊断标志物的研究[J].中华检验医学杂志,2010,33(6):492-496.
[4]金献冠,徐建国,杨燕阳,等.肾损伤分子-1在脓毒症急性肾损伤患者选择CRRT治疗时机中的参考价值[J].实用医学杂志,2016,32(10):1647-1649.
[5]蔡靓,刘占国,常平.脓毒症致急性肾损伤的机制及治疗研究进展[J].中华危重病急救医学,2013,25(7):444-446.
[6] Pérez-Fernández X,Sabater-Riera J,Sileanu F E,et al.Clinical variables associated with poor outcome from sepsisassociated acute kidney injury and the relationship with timing of initiation of renal replacement therapy[J].Journal of Critical Care,2017,40(12):154-160.
[7]张丽琴,唐正文,章向成,等.不同血液净化方法对脓毒症急性肾损伤患者血流动力学及预后的影响[J].中国老年学杂志,2017,37(24):166-167.
[8]沈威,吴克艳.连续性肾脏替代治疗对急性肾损伤重症患者肿瘤坏死因子-α与病死率的影响[J].中国中西医结合急救杂志,2016,23(1):49-50.
[9] Oh H J,Kim M H,Ahn J Y,et al.Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy[J].Journal of Critical Care,2016,35(15):51-56.
[10]戴甜,曹书华,杨晓龙.连续性肾脏替代治疗与间歇性血液透析对脓毒症急性肾损伤的临床疗效比较[J].中华危重病急救医学,2016,28(3):277-278.
[11]王绍红,刘金涛,袁通梅,等.CRRT在老年脓毒症患者治疗中的应用效果及其对血清炎性因子水平的影响[J].山东医药,2016,56(42):133-134.
[12] Park J Y,An J N,Jhee J H,et al.Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury:a multicenter prospective cohort study[J].Critical Care,2016,20(1):260-261.
[13]陈敏华,呼邦传,李茜,等.基于KDIGO分级的早期连续性肾脏替代治疗对重症急性肾损伤患者预后的影响[J].中华危重病急救医学,2016,28(3):246-247.
[14]苏伟,黄昭,杨智,等.血液灌流联合连续性血液滤过治疗脓毒血症并急性肾损伤[J].中国血液净化,2011,10(10):556-559.
[15]刘金涛,罗海丽,袁通梅,等.连续性肾脏替代治疗对老年脓毒症患者肠功能、免疫功能和预后转归的影响[J].山东医药,2017,57(10):112-113.
[16]ParkJT,LeeH,KeeYK,etal.High-DoseVersus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in SepsisAssociated Acute Kidney Injury:A Randomized Controlled Trial[J].American Journal of Kidney Diseases,2016,68(4):599-608.
[17]曾燕萍,马卫星,缪志军,等.右美托咪定治疗重症脓毒血症合并急性肺损伤和肾损伤患者的临床研究[J].中国临床药理学杂志,2017,11(15):144-145.
[18] Passos R D,Ramos J G,Gobatto A,et al.Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy A cohort study[J].Medicine,2016,95(40):e5112.
[19]王霞,谢红浪.容量负荷与危重患者急性肾损伤[J].肾脏病与透析肾移植杂志,2012,21(2):175-178.
[20]万林骏,廖庚进,万晓红,等.严重脓毒症和感染性休克患者早期复苏时器官功能障碍的回顾性分析[J].中华危重病急救医学,2016,28(5):418-419.
[2]胡辰.脓毒血症急性肾损伤的病理机制研究进展[J].国际泌尿系统杂志,2011,31(5):686-689.
[3]李萍珠,徐炜新.脓毒血症并发急性肾损伤早期诊断标志物的研究[J].中华检验医学杂志,2010,33(6):492-496.
[4]金献冠,徐建国,杨燕阳,等.肾损伤分子-1在脓毒症急性肾损伤患者选择CRRT治疗时机中的参考价值[J].实用医学杂志,2016,32(10):1647-1649.
[5]蔡靓,刘占国,常平.脓毒症致急性肾损伤的机制及治疗研究进展[J].中华危重病急救医学,2013,25(7):444-446.
[6] Pérez-Fernández X,Sabater-Riera J,Sileanu F E,et al.Clinical variables associated with poor outcome from sepsisassociated acute kidney injury and the relationship with timing of initiation of renal replacement therapy[J].Journal of Critical Care,2017,40(12):154-160.
[7]张丽琴,唐正文,章向成,等.不同血液净化方法对脓毒症急性肾损伤患者血流动力学及预后的影响[J].中国老年学杂志,2017,37(24):166-167.
[8]沈威,吴克艳.连续性肾脏替代治疗对急性肾损伤重症患者肿瘤坏死因子-α与病死率的影响[J].中国中西医结合急救杂志,2016,23(1):49-50.
[9] Oh H J,Kim M H,Ahn J Y,et al.Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy[J].Journal of Critical Care,2016,35(15):51-56.
[10]戴甜,曹书华,杨晓龙.连续性肾脏替代治疗与间歇性血液透析对脓毒症急性肾损伤的临床疗效比较[J].中华危重病急救医学,2016,28(3):277-278.
[11]王绍红,刘金涛,袁通梅,等.CRRT在老年脓毒症患者治疗中的应用效果及其对血清炎性因子水平的影响[J].山东医药,2016,56(42):133-134.
[12] Park J Y,An J N,Jhee J H,et al.Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury:a multicenter prospective cohort study[J].Critical Care,2016,20(1):260-261.
[13]陈敏华,呼邦传,李茜,等.基于KDIGO分级的早期连续性肾脏替代治疗对重症急性肾损伤患者预后的影响[J].中华危重病急救医学,2016,28(3):246-247.
[14]苏伟,黄昭,杨智,等.血液灌流联合连续性血液滤过治疗脓毒血症并急性肾损伤[J].中国血液净化,2011,10(10):556-559.
[15]刘金涛,罗海丽,袁通梅,等.连续性肾脏替代治疗对老年脓毒症患者肠功能、免疫功能和预后转归的影响[J].山东医药,2017,57(10):112-113.
[16]ParkJT,LeeH,KeeYK,etal.High-DoseVersus Conventional-Dose Continuous Venovenous Hemodiafiltration and Patient and Kidney Survival and Cytokine Removal in SepsisAssociated Acute Kidney Injury:A Randomized Controlled Trial[J].American Journal of Kidney Diseases,2016,68(4):599-608.
[17]曾燕萍,马卫星,缪志军,等.右美托咪定治疗重症脓毒血症合并急性肺损伤和肾损伤患者的临床研究[J].中国临床药理学杂志,2017,11(15):144-145.
[18] Passos R D,Ramos J G,Gobatto A,et al.Lactate clearance is associated with mortality in septic patients with acute kidney injury requiring continuous renal replacement therapy A cohort study[J].Medicine,2016,95(40):e5112.
[19]王霞,谢红浪.容量负荷与危重患者急性肾损伤[J].肾脏病与透析肾移植杂志,2012,21(2):175-178.
[20]万林骏,廖庚进,万晓红,等.严重脓毒症和感染性休克患者早期复苏时器官功能障碍的回顾性分析[J].中华危重病急救医学,2016,28(5):418-419.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |