连续肾脏替代治疗严重脓毒症的效果及对炎性因子水平的影响
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摘要
目的:研讨连续肾脏替代治疗严重脓毒症的效果及对炎性因子水平的影响。方法:随机从本院2016年5月-2018年7月收治的严重脓毒症患者中抽取80例进行讨论,按随机数字表法分组,其中40例接受血必净治疗(对照组),另40例在血必净治疗基础上再接受连续肾脏替代治疗(研究组)。观察比较两组治疗效果。结果:研究组治疗总有效率(95.00%)高于对照组(62.50%),差异有统计学意义(P<0.05)。两组治疗前各炎性因子比较,差异均无统计学意义(P>0.05)。治疗后,研究组高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白(hs-CRP)均低于对照组(P<0.05)。治疗前,两组CD14+、CD8+、CD4+、淋巴细胞计数比较,差异均无统计学意义(P>0.05)。治疗后,研究组CD14+、CD4+、淋巴细胞计数均高于对照组(P<0.05),而两组CD8+比较,差异无统计学意义(P>0.05)。结论:连续肾脏替代治疗严重脓毒症效果突出,且可显著改善其炎性因子水平和免疫指标,值得推广。
Objective:To discuss the effect of continuous renal replacement therapy on severe sepsis and its effect on level of inflammatory factors.Method:80 patients with severe sepsis treated in our hospital from May 2016 to July 2018 were randomly selected for discussion,and they were grouped by random number table method.Among them,40 cases were received Xuebijing treatment(control group),another 40 patients were received continuous renal replacement therapy on the basis of Xuebijing treatment(study group).The treatment effect of the two groups were observed and compared.Result:The total effective rate of the study group(95.00%) was higher than that of the control group(62.50%),the difference was statistically significant(P<0.05).The each inflammatory factors of the two groups before treatment were compared,the differences were not statistically significant(P>0.05).After treatment,the high mobility group protein B1(HMGB1),tumor necrosis factor-α(TNF-α),hypersensitive C reactive protein(hs-CRP) in the study group were lower than those in the control group(P<0.05).CD14+,CD8+,CD4+,lymphocyte counts of the two groups were compared before treatment,the differences were not statistically significant(P>0.05).After treatment,CD14+,CD4+ and lymphocyte counts in the study group were higher than those in the control group(P<0.05),while there was no significant difference in CD8+ between the two groups(P>0.05).Conclusion:The effect of continuous renal replacement therapy on severe sepsis was prominent.It can significantly improve the level of inflammatory factors and immune indicators,thus it is worth promoting.
Objective:To discuss the effect of continuous renal replacement therapy on severe sepsis and its effect on level of inflammatory factors.Method:80 patients with severe sepsis treated in our hospital from May 2016 to July 2018 were randomly selected for discussion,and they were grouped by random number table method.Among them,40 cases were received Xuebijing treatment(control group),another 40 patients were received continuous renal replacement therapy on the basis of Xuebijing treatment(study group).The treatment effect of the two groups were observed and compared.Result:The total effective rate of the study group(95.00%) was higher than that of the control group(62.50%),the difference was statistically significant(P<0.05).The each inflammatory factors of the two groups before treatment were compared,the differences were not statistically significant(P>0.05).After treatment,the high mobility group protein B1(HMGB1),tumor necrosis factor-α(TNF-α),hypersensitive C reactive protein(hs-CRP) in the study group were lower than those in the control group(P<0.05).CD14+,CD8+,CD4+,lymphocyte counts of the two groups were compared before treatment,the differences were not statistically significant(P>0.05).After treatment,CD14+,CD4+ and lymphocyte counts in the study group were higher than those in the control group(P<0.05),while there was no significant difference in CD8+ between the two groups(P>0.05).Conclusion:The effect of continuous renal replacement therapy on severe sepsis was prominent.It can significantly improve the level of inflammatory factors and immune indicators,thus it is worth promoting.
引文
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[6]雷湫宇,王沂芹,王代红,等.连续性血浆吸附联合血浆滤过治疗对脓毒症急性肾损伤患者免疫功能及预后的影响[J].河北医学,2017,23(8):1378-1383.
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[10]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):2145-2150.
[11]刘广明.连续性血液净化联合低分子肝素对严重脓毒症患者炎症因子的清除及肾脏保护作用[J].实用临床医药杂志,2015,19(3):44-46.
[12]温前宽,李彦,杨建萍,等.严重脓毒症患者炎症因子的动态变化及预后意义[J].中华急诊医学杂志,2015,24(7):779-783.
[13]祁俊,张逸,胡克苏,等.连续性肾脏替代治疗联合乌司他丁治疗对烧伤脓毒症患者炎性因子水平和血流动力学参数及预后的影响[J].中国医药,2017,12(11):1720-1724.
[14]姜启栋,张雪梅,伍长学.连续肾替代治疗加用不同剂量血必净对脓毒症合并急性肾损伤患者的影响[J].中国药房,2017.28(8):1087-1091.
[15]畅毅平,张玉强,张永利.连续性肾脏替代治疗脓毒症临床研究进展[J].临床肺科杂志,2017,22(2):344-346.
[16]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):2145-2150.
[17]崔巍,李新,虎琼华,等.脉波指数连续心搏量监测在连续肾脏替代疗法治疗脓毒症并发急性呼吸窘迫综合征患者中的临床价值[J].内科急危重症杂志,2017,23(6):486-489.
[18] de Souza Oliveira M A,Dos Santos T O C,Monte J C M,et al.The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function[J].BMC Nephrol,2017,18(1):150.
[19]吴燕生,郁毅刚,陈桂喜.连续肾脏替代疗法治疗脓毒症效果及炎症反应、血流动力学的变化[J].解放军医药杂志,2017,29(11):42-46.
[2]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华危重病急救医学,2015,27(6):401-426.
[3]吴晓弟,陈玉冰,吴翔,等.不同治疗剂量连续性肾脏替代疗法对严重脓毒症患者炎性因子、免疫功能及预后的影响研究[J].实用心脑肺血管病杂志,2016,24(B12):103-105.
[4]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):277-280.
[5]王健,王君,应伟,等.连续肾脏替代治疗对脓毒症患者血清中TNF-α、IL-6和IL-8表达的影响[J].现代生物医学进展,2015,15(31):6119-6121.
[6]雷湫宇,王沂芹,王代红,等.连续性血浆吸附联合血浆滤过治疗对脓毒症急性肾损伤患者免疫功能及预后的影响[J].河北医学,2017,23(8):1378-1383.
[7]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):97-98.
[8] Honore P M,Jacobs R,Hendrickx I,et al.Presepsin and sepsis-induced acute kidney injury treated with continuous renal replacement therapy:will another promising biomarker bite the dust?[J].Crit Care,2015,19(1):428.
[9]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):85-88.
[10]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):2145-2150.
[11]刘广明.连续性血液净化联合低分子肝素对严重脓毒症患者炎症因子的清除及肾脏保护作用[J].实用临床医药杂志,2015,19(3):44-46.
[12]温前宽,李彦,杨建萍,等.严重脓毒症患者炎症因子的动态变化及预后意义[J].中华急诊医学杂志,2015,24(7):779-783.
[13]祁俊,张逸,胡克苏,等.连续性肾脏替代治疗联合乌司他丁治疗对烧伤脓毒症患者炎性因子水平和血流动力学参数及预后的影响[J].中国医药,2017,12(11):1720-1724.
[14]姜启栋,张雪梅,伍长学.连续肾替代治疗加用不同剂量血必净对脓毒症合并急性肾损伤患者的影响[J].中国药房,2017.28(8):1087-1091.
[15]畅毅平,张玉强,张永利.连续性肾脏替代治疗脓毒症临床研究进展[J].临床肺科杂志,2017,22(2):344-346.
[16]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):2145-2150.
[17]崔巍,李新,虎琼华,等.脉波指数连续心搏量监测在连续肾脏替代疗法治疗脓毒症并发急性呼吸窘迫综合征患者中的临床价值[J].内科急危重症杂志,2017,23(6):486-489.
[18] de Souza Oliveira M A,Dos Santos T O C,Monte J C M,et al.The impact of continuous renal replacement therapy on renal outcomes in dialysis-requiring acute kidney injury may be related to the baseline kidney function[J].BMC Nephrol,2017,18(1):150.
[19]吴燕生,郁毅刚,陈桂喜.连续肾脏替代疗法治疗脓毒症效果及炎症反应、血流动力学的变化[J].解放军医药杂志,2017,29(11):42-46.