摘要
目的探讨重症加强治疗病房（ICU）急性肾损伤（AKI）危重患者连续性肾脏替代治疗（CRRT）后炎性介质清除量与病死率的关系。方法选择2012年1至2015年5月湖北省孝感市中心医院重症医学科收治96例危重患者为研究对象。73例行连续性静脉一静脉血液透析滤过（CVVHDF）的危重患者为CRRT组，23例未进行CRRT治疗的ICU重症患者为对照组。将CRRT组患者按预后分为存活组（32例）和死亡组（41例）；并按治疗后肿瘤坏死因子-α（TNF-α）清除量的不同分为TNF—α低（〈0．66ng／L）、中（0．66．3．22ng／L）、高（〉3．22ng／L）清除量组（每组15例）。比较各组性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、脓毒症发生率、接受腹部手术率、胰腺炎发生率的差异；检测人院时及治疗后24h各组血肌酐（SCr）、尿素氮（BUN）、乳酸（Lac）、C-反应蛋白（CRP）水平的变化，以及入院时和治疗后6、24h血浆补体C3a（C3a）、TNF-α、白细胞介素（IL-10、IL-6、IL-1B）水平[用酶联免疫吸附试验（ELISA）测定]。比较CRRT组不同预后及不同TNF-α清除量各组的机械通气和血管活性药物使用率，以及CRRT组和对照组预期病死率及低、中、高TNF-α清除量3组患者的住院病死率。二元logistic回归分析TNF-α对AKI重症患者病死率的预测价值。结果CRRT组预期病死率明显高于对照组[（66．5±24．6）％比（44．3±14．8）％]。入院时CRRT组SCr、BUN均明显高于对照组[SCr（pmol／L）：185．9±141．6比97．4±46．5，BUN（mmol／L）：28．6±18．2比16．7±20．7，均P〈0．05]，但两组Lac、CRP比较差异无统计学意义（均P〉0．05）；治疗24h后CRRT组BUN明显低于对照组（mmol／L：19．2±10．9比23．2±153，P〈0．05），Lac明显高于对照组（mmol／L：63±5．1比3．1±1．8，P〈0．05）。CRRT死亡组患者脓毒症发生率、
[Abstract] Objective To investigate the relationship between removal quantities of inflammatory mediators and the mortality in critically ill patients with acute renal injury （AKI） after continuous renal replacement therapy （CRRT） in intensive care unit （ICU）. Methods Ninety-six critically ill patients in Critical Care Medicine of Xiaogan Central Hospital in Hubei Province from Januray 2012 to May 2015 were conducted, 73 patients of them treated with continuous venous-venous hemodiafiltration （CVVHDF） were in the CRRT group, and 23 severe patients in critical care medicine not treated with CRRT were assigned in the control group; according to the prognosis in the CRRT group, the patients were divided into survival group （32 cases） and death group （41 cases）; and according to the different clearance amount of tumor necrosis factor- α（TNF-α ） after CVVHDF, the CRRT group was subdivided into TNF-α low （〈 0.66 ng/L）, middle （0.66 - 3.22 ng/L） and high （〉 3.22 ng/L） clearance groups （15 cases in each group）. The sex, age, acute physiology and chronic health evaluation Ⅱ （APACHEⅡ ） score, the incidence of sepsis, the rate of receiving abdominal operation, the incidence of pancreatitis were compared among various groups; the changes of serum creatinine （SCr）, blood urea nitrogen （BUN）, lactic acid （Lac）, C-reactive protein （CRP） levels were measured on admission and 24 hours after treatment; the levels of serum complement C3a （C3a）,TNF- oL and interleukin （IL-10, IL-6, IL-1β ） in two groups were determined by enzyme linked immunosorbent assay （ELISA） on admission and 6 hours and 24 hours after treatment respectively. The usage rates of mechanical ventilation and vasoactive drug were compared in CRRT group with different prognosis and different TNF-α deputation rate groups; the expected mortalities in CRRT group and control group were compared, and mortalities in low, middle and high TNF-α removal quantity groups were compared. The
出处
《中国中西医结合急救杂志》
CAS
北大核心
2016年第1期85-88,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
急性肾损伤
连续性静脉-静脉血液透析滤过
炎性因子
连续性肾脏替代治疗
Acute kidney injury
Continuous venous-venous hemodiafiltration
Inflammatory cytokines
Continuous renal replacement therapy
