连续肾脏替代疗法治疗腹腔高压第三间隙效应患者的临床研究
|
摘要
目的探讨连续肾脏替代疗法(CRRT)对腹腔高压第三间隙效应患者的临床疗效。方法选择2015年4月—2017年3月在绍兴市中心医院确诊且符合纳入标准的86例以第三间隙液体潴留为主的腹腔高压患者,按照随机数字表法分为观察组和对照组各43例,对照组给予常规治疗,观察组在对照组的基础上采用CRRT治疗,比较治疗前后2组患者的治疗效果以及肾功能和炎症因子的变化情况。结果观察组有效率为88. 4%,对照组有效率为69. 8%,观察组总有效率明显高于对照组(P <0. 05); 2组患者治疗前血肌肝(SCr)、尿素氮(BUN)指标比较差异无统计学意义(均P>0. 05),治疗3 d后,2组患者的SCr和BUN指标与治疗前相比均有明显降低(均P <0. 05),且观察组治疗前后差值(降低程度)明显高于对照组(均P <0. 05); 2组患者治疗前肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6和C反应蛋白(CRP)水平比较差异无统计学意义(均P> 0. 05),治疗3 d后,2组患者的TNF-α、IL-6和CRP水平与治疗前相比均有明显降低(均P <0. 05),且观察组治疗前后差值(降低程度)明显高于对照组(均P <0. 05); 2组患者治疗前腹内压相比差异无统计学意义(P> 0. 05),治疗3 d后,2组患者腹内压与治疗前相比均明显降低(P <0. 05),且观察组治疗前后差值(降低程度)明显高于对照组(P <0. 05)。结论 CRRT治疗以第三间隙液体潴留为主的腹腔高压患者效果显著,能够有效降低细胞炎症因子,改善肾功能指标,值得临床推广。
Objective To investigate the therapeutic effect of continuous renal replacement therapy( CRRT) in the treatment of third-spacing in patients with intra-abdominal hypertension( IAH). Methods A total of 86 cases of intra-abdominal hypertension with third-space fluid shift facing inclusion criteria in our hospital between April 2015 and Mar 2017 were enrolled and divided into treatment group( 43 cases) and control group( 43 cases) according to the random number table method. The control group was given routine treatment,while the observation group received additional CRRT based on the routine treatment. The therapeutic effect and the changes of renal function and inflammatory factors were compared between the two groups before and after the treatment. Results The effective rate of the treatment group was 88. 4%; in the control group,the effective rate was 69. 8%,it was significantly lower than that of the treatment group( P < 0. 05); There was no significant difference in serum creatinine( SCr) and blood urea nitrogen( BUN) between the two groups before the treatment( all P > 0. 05),3 days after the treatment. The SCr and BUN parameters of the two groups were significantly lower than those before the treatment( all P < 0. 05),and the difference( decrease degree) before and after treatment in the observation group was significantly higher than that in the control group( all P < 0. 05); There was no significant difference in the levels of tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and C-reactive protein( CRP) between the two groups before treatment( all P > 0. 05),3 days after the treatment,the levels of TNF-α,IL-6 and CRP in the two groups were significantly lower than those before the treatment( all P < 0. 05),and the difference( decrease degree) before and after the treatment in the observation group was significantly higher than that in the control group( all P < 0. 05); There was no significant difference in intraperitoneal pressure between the two groups before the treatment( P > 0. 05),but 3 days after the treatment,the intraperitoneal pressure of the two groups were significantly lower than those before the treatment( P <0. 05),and the difference( decrease degree) before and after the treatment in the observation group was significantly higher than that in the control group( P < 0. 05). Conclusion CRRT shows dramatic effect in the treatment of intra-abdominal hypertension patients with third spacing fluid,it can effectively reduce cell inflammatory factors and improve renal function.
Objective To investigate the therapeutic effect of continuous renal replacement therapy( CRRT) in the treatment of third-spacing in patients with intra-abdominal hypertension( IAH). Methods A total of 86 cases of intra-abdominal hypertension with third-space fluid shift facing inclusion criteria in our hospital between April 2015 and Mar 2017 were enrolled and divided into treatment group( 43 cases) and control group( 43 cases) according to the random number table method. The control group was given routine treatment,while the observation group received additional CRRT based on the routine treatment. The therapeutic effect and the changes of renal function and inflammatory factors were compared between the two groups before and after the treatment. Results The effective rate of the treatment group was 88. 4%; in the control group,the effective rate was 69. 8%,it was significantly lower than that of the treatment group( P < 0. 05); There was no significant difference in serum creatinine( SCr) and blood urea nitrogen( BUN) between the two groups before the treatment( all P > 0. 05),3 days after the treatment. The SCr and BUN parameters of the two groups were significantly lower than those before the treatment( all P < 0. 05),and the difference( decrease degree) before and after treatment in the observation group was significantly higher than that in the control group( all P < 0. 05); There was no significant difference in the levels of tumor necrosis factor-α( TNF-α),interleukin-6( IL-6) and C-reactive protein( CRP) between the two groups before treatment( all P > 0. 05),3 days after the treatment,the levels of TNF-α,IL-6 and CRP in the two groups were significantly lower than those before the treatment( all P < 0. 05),and the difference( decrease degree) before and after the treatment in the observation group was significantly higher than that in the control group( all P < 0. 05); There was no significant difference in intraperitoneal pressure between the two groups before the treatment( P > 0. 05),but 3 days after the treatment,the intraperitoneal pressure of the two groups were significantly lower than those before the treatment( P <0. 05),and the difference( decrease degree) before and after the treatment in the observation group was significantly higher than that in the control group( P < 0. 05). Conclusion CRRT shows dramatic effect in the treatment of intra-abdominal hypertension patients with third spacing fluid,it can effectively reduce cell inflammatory factors and improve renal function.
引文
[1]宋士更,潘腾,袁雪珮,等.胃肠型腹腔高压及腹腔间室综合征32例临床分析[J].岭南急诊医学杂志,2016,21(3):235-236,244.
[2]刘晓政,郭一民.生长抑素联合奥美拉唑对重症胰腺炎患者腹内高压及肠道黏膜屏障功能的影响[J].中国老年学杂志,2015,35(6):1479-1481.
[3]汪龙,麦威.腹腔镜术后第三间隙效应的研究概况[J].中国临床新医学,2016,9(4):365-368.
[4]张磊,吕光宇,黄典,等.持续性血液净化治疗对腹腔内高压患者的胃肠功能障碍的影响[J].中华临床医师杂志(电子版),2016,10(4):212-213.
[5]傅建军,朱宏亮,陈帆,等.连续性血液滤过在治疗以第三间隙液体潴留为主的腹腔高压中的应用[J].南昌大学学报(医学版),2014,54(2):48-52,77.
[6]王志超,林荣武,周建甫,等.腹腔镜根治性膀胱切除术后急性肾损伤的防治[J].临床泌尿外科杂志,2017,32(1):23-25.
[7]周滇,侯祚琼,章宏伟,等.特重度烧伤合并腹腔内高压对肾功能影响的相关性研究[J].南京医科大学学报(自然科学版),2013,33(6):842-845.
[8]白琳,史颜梅,周雅婷,等.腹内压测量的研究进展[J].护理学杂志,2016,31(11):109-112.
[9]赵晓萍,孔华卿,应杰.羟乙基淀粉对重症急性胰腺炎合并腹腔高压患者腹内压和炎症因子的影响[J].浙江创伤外科,2016,21(3):524-526.
[10]汪龙,李雷,麦威,等.腹腔镜结直肠癌根治术后第三间隙效应的临床研究[J].广西医学,2015,37(10):1387-1390.
[11]汪龙,麦威.腹腔镜术后第三间隙效应的研究概况[J].中国临床新医学,2016,9(4):365-368.
[12]袁亚松.连续性血液滤过在治疗以第三间隙液体潴留为主的腹腔高压中的应用[J].大家健康(学术版),2015,9(17):99.
[13]于荣强,杨巧巧.连续肾脏替代疗法在感染性休克所致急性肾功能衰竭的疗效评价[J].中国医药指南,2015,13(21):164-165.
[14]何亮.连续血液滤过联合甘露醇治疗颅内高压合并肾功能衰竭的临床疗效[J].当代医药论丛,2014,12(1):77-78.
[15]刘培,段美丽.持续床旁肾替代疗法治疗重症急性胰腺炎合并急性肾损伤的疗效观察[J].山东医药,2016,56(1):92-93.
[16]邢朝阳,杨玉军. CRRT治疗急性重症胰腺炎并发急性肾功能衰竭的疗效观察[J].浙江临床医学,2015,17(11):1882-1883.
[17]梁雪,张佩生,王卫平,等.顽固性心力衰竭心肾综合征患者的肾脏损害评估及CRRT支持对患者心肾功能的影响[J].中国实用医药,2013,8(9):40-41.
[18]高海丽,梁海军,王新伟,等.晚期重症肝炎患者合并肝肾综合征治疗效果的研究[J].中华医院感染学杂志,2014,24(6):1455-1457.
[19]晁莉.连续肾脏替代疗法治疗急性重症胰腺炎合并急性肾功能衰竭的临床研究[J].中外医疗,2016,35(20):6-9.
[20]高永霞,刘梅红,张劲松,等.股静脉双腔血液透析导管135例护理体会[J].中国临床研究,2015,28(12):1686-1688.
[2]刘晓政,郭一民.生长抑素联合奥美拉唑对重症胰腺炎患者腹内高压及肠道黏膜屏障功能的影响[J].中国老年学杂志,2015,35(6):1479-1481.
[3]汪龙,麦威.腹腔镜术后第三间隙效应的研究概况[J].中国临床新医学,2016,9(4):365-368.
[4]张磊,吕光宇,黄典,等.持续性血液净化治疗对腹腔内高压患者的胃肠功能障碍的影响[J].中华临床医师杂志(电子版),2016,10(4):212-213.
[5]傅建军,朱宏亮,陈帆,等.连续性血液滤过在治疗以第三间隙液体潴留为主的腹腔高压中的应用[J].南昌大学学报(医学版),2014,54(2):48-52,77.
[6]王志超,林荣武,周建甫,等.腹腔镜根治性膀胱切除术后急性肾损伤的防治[J].临床泌尿外科杂志,2017,32(1):23-25.
[7]周滇,侯祚琼,章宏伟,等.特重度烧伤合并腹腔内高压对肾功能影响的相关性研究[J].南京医科大学学报(自然科学版),2013,33(6):842-845.
[8]白琳,史颜梅,周雅婷,等.腹内压测量的研究进展[J].护理学杂志,2016,31(11):109-112.
[9]赵晓萍,孔华卿,应杰.羟乙基淀粉对重症急性胰腺炎合并腹腔高压患者腹内压和炎症因子的影响[J].浙江创伤外科,2016,21(3):524-526.
[10]汪龙,李雷,麦威,等.腹腔镜结直肠癌根治术后第三间隙效应的临床研究[J].广西医学,2015,37(10):1387-1390.
[11]汪龙,麦威.腹腔镜术后第三间隙效应的研究概况[J].中国临床新医学,2016,9(4):365-368.
[12]袁亚松.连续性血液滤过在治疗以第三间隙液体潴留为主的腹腔高压中的应用[J].大家健康(学术版),2015,9(17):99.
[13]于荣强,杨巧巧.连续肾脏替代疗法在感染性休克所致急性肾功能衰竭的疗效评价[J].中国医药指南,2015,13(21):164-165.
[14]何亮.连续血液滤过联合甘露醇治疗颅内高压合并肾功能衰竭的临床疗效[J].当代医药论丛,2014,12(1):77-78.
[15]刘培,段美丽.持续床旁肾替代疗法治疗重症急性胰腺炎合并急性肾损伤的疗效观察[J].山东医药,2016,56(1):92-93.
[16]邢朝阳,杨玉军. CRRT治疗急性重症胰腺炎并发急性肾功能衰竭的疗效观察[J].浙江临床医学,2015,17(11):1882-1883.
[17]梁雪,张佩生,王卫平,等.顽固性心力衰竭心肾综合征患者的肾脏损害评估及CRRT支持对患者心肾功能的影响[J].中国实用医药,2013,8(9):40-41.
[18]高海丽,梁海军,王新伟,等.晚期重症肝炎患者合并肝肾综合征治疗效果的研究[J].中华医院感染学杂志,2014,24(6):1455-1457.
[19]晁莉.连续肾脏替代疗法治疗急性重症胰腺炎合并急性肾功能衰竭的临床研究[J].中外医疗,2016,35(20):6-9.
[20]高永霞,刘梅红,张劲松,等.股静脉双腔血液透析导管135例护理体会[J].中国临床研究,2015,28(12):1686-1688.