CRRT联合CPPL对腹腔脓毒性休克患者血浆Apelin水平的影响  

Change of Plasma Apelin Concentration in Patients with Intra-abdominal Septic Shock after CPPL and CRRT

作　　者：童静[1] 张明[1] 程碧环[1] 金胜威[2] 范小芳[2] 

机构地区：[1]温州医学院附属第二医院急救中心重症医学科,325000 [2]温州医学院基础学院机能实验教学中心,325000

出　　处：《医学研究杂志》2013年第6期129-133,共5页Journal of Medical Research

基　　金：温州市科技局资助项目(Y20100064)

摘　　要：目的观察持续肾脏替代治疗(continuous renal replacement therapy,CRRT)及持续腹腔灌洗引流(continuous postop-erative peritoneal lavage,CPPL)对腹腔脓毒性休克患者血浆Apelin水平的影响。方法入选39例腹腔脓毒性休克患者(IN),常规给予液体复苏、升压药、应用抗生素等治疗。所有患者行手术清除坏死组织并予CPPL,根据有无CRRT,分为仅CPPL(IN1)组及CPPL+CRRT(IN2)组,分别在治疗前、治疗后24h及治疗后48h(即A、B、C 3个时间点)经肘静脉途径采血,检测血PCT水平、放免法测定血浆Apelin水平;评估APACHEⅡ得分及入住ICU时间。17例健康志愿者为对照组(NC组)。结果血浆Ape-lin水平比较:IN组比NC组有显著升高(P<0.01);IN1组内C点比A点下降(P<0.05);IN2组内,B、C点比A点均有显著下降(P<0.01);IN2组比IN1组在B点及C点有显著下降(P<0.05)。血PCT水平:在IN1组在C点较A点有下降(P<0.05);IN2组,与A点比较,B点有下降(P<0.05),C点有显著下降(P<0.01);IN2组比IN1组在B点及C点有显著下降(P<0.05);IN组血浆Apelin水平与PCT水平有相关性(r=0.466,P<0.05);APACHEⅡ评分比较:IN1组在C点比A点降低(P<0.05);IN2内,B、C点比A点均有显著下降(P<0.01);IN2组比IN1组在B点及C点有下降(P<0.05);IN2组比IN1组入住ICU时间短(P<0.05)。结论腹腔脓毒性休克患者血浆Apelin水平升高,与血PCT水平有显著正相关,经CPPL联合CRRT后均能显著降低;2种方法联合能较快降低PCT水平,能改善APACHEⅡ评分并缩短入住ICU时间。Objective To evaluate the change of plasma Apelin in patients of intra - abdominal septic shock after CPPL and CRRT. Methods Totally 39 patients who was diagnosed intra - abdominal septic shock （ IN ） were clinic randomly divided into CPPL （ IN1 ） group, CPPL ＋ CRRT（IN2） group. The blood were collected from the ulnar vein at three different time such as before treatment,24 hours after treatment and 48 hours after treatment （called A, B, C）. Seventeen volunteers as normal control （NC） group were enrolled in the study. The concentration of plasma Apelin were measured by radioimmunoassay. The level of PCT were measured. The score of APACHE II and the time of ICU admission were evaluated. Results The concentration of plasma Apelin in IN group significantly increased compared with NC group at A （P 〈 0.01 ）. It significantly reduced at C compared with A in IN1 group（P 〈 0.05 ）. It significantly reduced at B and C compared with A in IN2（P 〈0.01）. It significantly reduced in IN2 group compared with INI at B and C（P 〈0.01）. The level of PCT significantly reduced at C compared with A in IN1 group（P 〈0.05）. It were descent at B（P 〈0.05） and significantly descent at C （P 〈 0.01 ） compared with A. It was significantly descent in IN2 group compared with IN1 at B and C（ P 〈0.01 ）. The plasma Apelin concentration in IN was positive correlated with the concentration of PCT （ r = 0. 466 ,P 〈 0.05 ）. The scores of APACHE II in INI group were significantly descent at C compared with at A （ P 〈 0.05 ） , and were significantly descent at B and C compared with A in IN2 group （ P 〈 0. 01 ）. They were were significantly descent in IN2 group compared with IN1 at B and C （ P 〈 0.05 ）. The time of ICU admission were shorter in IN2 group compared with IN1 group（P 〈 0.05）. Conclusion The level of plasma Apelin and PCT significantly descend, the score of APACHE II improved and the time of ICU admission reduced after CRRT and CPPL in patients wit

关 键 词：脓毒性休克 APELIN CRRT 腹腔感染 APACHEⅡ 

分 类 号：R341.2[医药卫生—基础医学]