血清ET-1水平对连续性肾脏替代治疗非计划下机和疗效的指示性作用分析
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摘要
目的考察血清内皮素-1(ET-1)水平对连续性肾脏替代治疗非计划下机和疗效的指示性作用。方法 180例重症监护室患者入院后均接受对连续性肾脏替代治疗(CRRT),测定患者治疗前和治疗后4 d血清ET-1水平并选取30例健康对照。分析血清ET-1水平与APACHEⅡ及非计划下机的相关性。结果 180例患者中非计划下机29例,非计划下机率16.1%。77例治疗前后病菌学检查均为阴性(Ⅰ组),79例前后病菌学检查均为阳性(Ⅱ组),24例治疗前阴性但治疗72 h后出现病原学阳性(Ⅲ组)。所有患者中血清ET-1水平显著高于健康对照(P<0.05)。且Ⅱ组和Ⅲ组患者显著高于I组患者(P<0.05)。动态观察显示,Ⅰ组患者治疗后血清ET-1水平显著下降(P<0.05),但其他两组无显著变化(P>0.05)。非计划下机患者血清ET-1水平显著高于其他患者(P<0.05)。治疗前和治疗后4 d血清ET-1与APACHEⅡ评分均显著正相关(r=0.61,r=0.77,P<0.05)。结论血清ET-1是CRRT患者病情严重程度的有效指示,治疗后的ET-1对患者预后评价效果更优。
Objective To investigate the indicative effect of serum endothelin-1(ET-1) level on unplanned disembarkation and outcomes of continuous renal replacement therapy. Methods 180 patients in intensive care unit received continuous renal replacement therapy(CRRT) after admission. Serum ET-1 levels were measured before and 4 days after treatment, and 30 healthy controls were selected. To analyze the correlation between serum ET-1 level and APACHEⅡ and unplanned disembarkation. Results Among 180 patients, 29(16.1%) were unplanned disembarkation. 77 cases were negative before and after treatment(groupⅠ), 79 cases were positive before and after treatment(groupⅡ), 24 cases were negative before treatment but positive after 72 hours of treatment(groupⅢ). The level of serum ET-1 in all patients was significantly higher than that in healthy controls(P<0.05). And groupⅡ and groupⅢ were significantly higher than groupⅠ(P<0.05). Dynamic observation showed that the level of serum ET-1 in group I decreased significantly after treatment(P<0.05), but there was no significant change in other two groups(P>0.05). The level of serum ET-1 in unplanned patients was significantly higher than that in other patients(P<0.05). Serum ET-1 was positively correlated with APACHEⅡ scores before and 4 days after treatment(r=051,r=0.72,P<0.05).Conclusion Serum ET-1 is an effective indicator of the severity of CRRT, and ET-1 is more effective in evaluating CRRT patients after treatment.
Objective To investigate the indicative effect of serum endothelin-1(ET-1) level on unplanned disembarkation and outcomes of continuous renal replacement therapy. Methods 180 patients in intensive care unit received continuous renal replacement therapy(CRRT) after admission. Serum ET-1 levels were measured before and 4 days after treatment, and 30 healthy controls were selected. To analyze the correlation between serum ET-1 level and APACHEⅡ and unplanned disembarkation. Results Among 180 patients, 29(16.1%) were unplanned disembarkation. 77 cases were negative before and after treatment(groupⅠ), 79 cases were positive before and after treatment(groupⅡ), 24 cases were negative before treatment but positive after 72 hours of treatment(groupⅢ). The level of serum ET-1 in all patients was significantly higher than that in healthy controls(P<0.05). And groupⅡ and groupⅢ were significantly higher than groupⅠ(P<0.05). Dynamic observation showed that the level of serum ET-1 in group I decreased significantly after treatment(P<0.05), but there was no significant change in other two groups(P>0.05). The level of serum ET-1 in unplanned patients was significantly higher than that in other patients(P<0.05). Serum ET-1 was positively correlated with APACHEⅡ scores before and 4 days after treatment(r=051,r=0.72,P<0.05).Conclusion Serum ET-1 is an effective indicator of the severity of CRRT, and ET-1 is more effective in evaluating CRRT patients after treatment.
引文
[1] 齐中意,彭湘鹤,颜璐,等.低分子肝素对脓毒血症患者凝血功能和肾功能的影响[J].解放军预防医学杂志,2018,36(1):84.
[2] 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.
[3] LIU C,MAO Z,KANG H,et al.Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a meta-analysis with trial sequential analysis of randomized controlled trials[J].Critical Care,2016,20(1):144.
[4] HICKS P,COOPER D J.The surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. An assessment by the Australian and New Zealand intensive care society[J].Critical Care & Resuscitation,2008,10(1):8.
[5] 马雅琳,陈思,史媛媛,等.连续性肾脏替代治疗非计划性下机的影响因素及防范策略[J].中国老年学杂志,2017(3).
[6] LI L,WEI Z,NAN Y,et al.ET-1 Promotes Differentiation of Periodontal Ligament Stem Cells into Osteoblasts through ETR, MAPK, and Wnt/r, βr,-Catenin Signaling Pathways under Inflammatory Microenvironment[J].Mediators of Inflammation,2016,2016:1.
[7] ROMI M M,ARFIAN N,TRANGGONO U,et al.Uric acid causes kidney injury through inducing fibroblast expansion, Endothelin-1 expression, and inflammation[J].BMC Nephrology,2017,18(1):326.
[2] 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.
[3] LIU C,MAO Z,KANG H,et al.Regional citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill patients: a meta-analysis with trial sequential analysis of randomized controlled trials[J].Critical Care,2016,20(1):144.
[4] HICKS P,COOPER D J.The surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. An assessment by the Australian and New Zealand intensive care society[J].Critical Care & Resuscitation,2008,10(1):8.
[5] 马雅琳,陈思,史媛媛,等.连续性肾脏替代治疗非计划性下机的影响因素及防范策略[J].中国老年学杂志,2017(3).
[6] LI L,WEI Z,NAN Y,et al.ET-1 Promotes Differentiation of Periodontal Ligament Stem Cells into Osteoblasts through ETR, MAPK, and Wnt/r, βr,-Catenin Signaling Pathways under Inflammatory Microenvironment[J].Mediators of Inflammation,2016,2016:1.
[7] ROMI M M,ARFIAN N,TRANGGONO U,et al.Uric acid causes kidney injury through inducing fibroblast expansion, Endothelin-1 expression, and inflammation[J].BMC Nephrology,2017,18(1):326.