NMRC-DHP联合CVVH对脓毒血症合并急性肾损伤患者IL-6和TNF-α水平及器官功能的影响  

Study on the effect of combined NMRC- DHP with CVVH on levels of IL-6 and TNF-α and impact on organ function in treatment of patients with sepsis and acute renal impairment

作　　者：周海琪[1] 陈明祺[1] 裴颖皓[1] 张海东[1] 吕海[1] 王醒[1] 

机构地区：[1]南京中医药大学附属江苏省中医院重症医学科,江苏南京210000

出　　处：《临床和实验医学杂志》2015年第7期580-582,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨中性大孔径树脂血液灌流(NMRC-DHP)联合连续性静脉-静脉滤过(CVVH)对脓毒血症合并急性肾损伤患者白介素6(IL-6)、肿瘤坏死因子α(TNF-α)水平及器官功能的影响。方法选择脓毒血症合并急性肾损伤患者共46例,随机分为研究组和对照组(各23例),研究组行NMRC-DHP+CVVH治疗,对照组只进行CVVH。通过序贯器官衰竭评分(SOFA)、氧合指数(OI)、平均动脉压(MAP)以及血清白介素6(IL-6)和肿瘤坏死因子α(TNF-α)的水平变化,评价两者在对脓毒血症合并急性肾损伤患者的疗效。结果治疗后24 h和治疗后72 h,两组血清IL-6和IL-10水平较治疗前均出现了显著下降(P<0.05),研究组治疗后显著低于对照组(P<0.05)。治疗后两组OI和MAP出现显著上升,Scr出现明显下降(P<0.05),研究组治疗后24 h、72 h的OI、MAP显著高于对照组,Scr显著低于对照组(P<0.05)。治疗后3 d和7 d两组SOFA评分均显著下降,研究组SOFA评分显著低于对照组(P<0.05)。结论脓毒血症合并急性肾损伤患者采用NMRC-DHP联合CVVH治疗能有效清除炎症介质,保护脏器功能,有助于肾功能的早期恢复。Objective To explore the effect of NMRC- DHP combined with continuous venous- venous hemofiltration（ CVVH） on levels of IL- 6 and TNF- α and impact on organ function in treatment of patients with sepsis complicated with acute renal impairment. Methods A total of 46 patients with sepsis and acute renal impairment were selected and randomly divided into study group and control group（ 23 cases in each group）. Patients in study group were given with NMRC- DHP plus CVVH,and patients in control group were only given with continuous venous- venous hemofiltration（ CVVH）. The effect of treatment with NMRC plus CVVH in patients with sepsis and acute renal impairment was evaluated by sequential organ failure assessment（ SOFA）,oxygenation index（ OI）,mean arterial pressure（ MAP） and changes in serum levels of interleukin- 6（ IL- 6） and tumor necrosis factor- α（ TNF- α）. Results Serum levels of IL- 6 and IL- 10 in patients of these 2 groups at24 h and 72 h after treatment had significantly declined in comparison with those before treatment. In patients of study group after treatment,those levels were significantly lower than those of control group. After treatment,OI and MAP in patients of these two groups were significantly increased and Scr was significantly declined. OI and MAP in patients of study group at 24 h and 72 h after treatment were significantly higher than those of patients in control group,and Scr in study group was significantly lower than that of control group. SOFA scores in patients of these 2 groups at 3d and 7d after treatment were significantly decreased. SOFA scores in study group were significantly lower than those of control group. Conclusion The application of NMRC- DHP combined with CVVH in treatment of patients with sepsis complicated with acute renal impairment can effectively remove inflammatory mediators,protect organ function and contribute to the early recovery of their renal function.

关 键 词：脓毒血症 急性肾损伤 NMRC-DHP CVVH IL-6 TNF-α 

分 类 号：R692[医药卫生—泌尿科学] R459.7[医药卫生—外科学]