摘要
目的:研究早期行持续肾脏替代疗法(CRRT)治疗肠外瘘致腹腔感染并发急性肾功能损伤(AKI)的疗效观察。方法:回顾性分析2015年1月至2018年9月中国人民解放军联勤保障部队第九四〇医院(原兰州军区总医院)收治的肠外瘘致腹腔感染并发AKI行CRRT治疗的24例病人,根据改善全球肾脏病预后组织(KDIGO)分期将其分为两组,其中10例为早期观察组即AKI达到KDIGO 1期,其余14例为对照组即AKI达到KDIGO 2期,共同采用连续静-静脉血液透析滤过(CVVHDF)模式,持续透析72 h,观察两组病人行CRRT治疗前、治疗第3日,治疗第6日,治疗第9日的血浆中C-反应蛋白、降钙素原、中性粒细胞百分比,白细胞计数、IL-10、内毒素,白蛋白、前白蛋白、转铁蛋白的数据变化,统计治疗前后平均住院时间、APACHEⅡ评分和90 d死亡率。结果:早期观察组平均住院时间和90 d死亡率,APACHEⅡ评分,C-反应蛋白,降钙素原,白细胞计数、IL-10,内毒素,均低于对照组,差异均有统计学意义(P<0.05)。而且早期观察组病人的白细胞,白细胞介素IL-10,内毒素,血肌酐值上升幅度及速率均小于对照组,差异均有统计学意义(P<0.05)。早期观察组病人在治疗后白蛋白、前白蛋白、转铁蛋白均与对照组有明显差异,差异有统计学意义(P<0.05)。结论:早期行CRRT治疗对后期治疗中腹腔感染的控制、病人营养的提升及全身脏器功能保护具有一定意义。
Objective:To study the effect of early CRRT treatment of intra-abdominal infection complicated with AKI caused by external intestinal fistula.Methods:From January 2015 to September 2018,24 patients with intraabdominal infection caused by enterocutaneous fistula and complicated with AKI were analyzed retrospectively.According to the KDIGO stage of AKI,they were divided into two groups,10 of them were in the early observation group,i.e.AKI reached KDIGO stage 1,and 14 of them were in the control group,i.e.AKI reached KDIGO stage 2 was the standard.Continuous veno-venous haemodiafiltration(CVVHDF)was used for 72 hours.The plasma C-reactive protein,procalcitonin,Percentage of neutrophils neutrophile granulocyte,leukocyte count,IL-10,endotoxin,albumin,prealbumin,transferrin,mean length of stay before and after treatment,APACHEⅡ score and 90 day mortality rate were analyzed.Results:The average hospitalization time and 90 day mortality rate,APACHEⅡ score,C-reactive protein,procalcitonin,leukocyte count,IL-10,endotoxin,albumin,prealbumin and transferrin in the early observation group were lower than those in the control group,the difference was statistically significant(P<0.05).The increase rate of IL-10,endotoxin and serum creatinine in the early observation group was lower than that in the control group(P<0.05).Conclusion:Early CRRT treatment has certain significant in the control of intra-abdominal infection,the improvement of patient’s nutrition and the protection of systemic organ function.
作者
段光辉
田运
王海霖
马凯
陈鹏
许鑫鑫
李洪涛
DUAN Guang-hui;TIAN Yun;WANG Hai-lin;MA Kai;CHEN Peng;XU Xin-xin;LI Hong-tao(Graduate School of Ningxia Medical University,Yinchuan 750004,Ningxia,China;General surgery,940 Hospital of the joint service support force of the people's Liberation Army,Lanzhou 730050,Gansu,China)
出处
《肠外与肠内营养》
CSCD
北大核心
2020年第2期72-77,共6页
Parenteral & Enteral Nutrition
基金
国家科技部、财政部惠民计划项目(2012GS620101)
甘肃省科技重大专项基金资助项目(2011GS04390)
甘肃省自然科学基金资助项目(1506RJZA309)
中国博士后科学基金资助项目(2015M572710)。
关键词
腹腔感染
急性肾损伤
肠瘘
感染指标
Abdominal infection
Acute renal injury
Intestinal fistula
Infection index
