CRRT治疗脓毒血症合并AKI患者的临床观察及护理  

Clinical observation and nursing of CRRT in treating septicopyemia with AKI

作　　者：安克润[1] 曹昉[1] 冷彦飞[1] 罗小兰[1] 王蓉[1] 袁建红[1] 尹贤[1] 秦超芬 

机构地区：[1]凉山彝族自治州第一人民医院肾病内科血液净化室,四川西昌615000

出　　处：《西部医学》2016年第12期1758-1761,共4页Medical Journal of West China

基　　金：四川省科技厅资助项目(2016152)

摘　　要：目的探讨连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）对脓毒血症合并急性肾损伤（AKI）患者的影响及护理。方法回顾性分析我院2012年1月～2014年7月诊治的92例脓毒血症合并AKI患者的临床资料，根据治疗方式分为CRRT组40例和对照组52例，CRRT组予CRRT治疗及专科护理，对照组予常规药物治疗及护理。对比两组患者治疗前与治疗3d后的生命体征、血清学指标和治疗7、28d时的护理效果及病死率；同时采用ROC分析作图计算CRRT治疗延迟时间对患者28d死亡率的影响。结果两组患者治疗3d后的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、尿量和氧饱和度（SpO2）均显著好于治疗前（均P〈0．05）；CRRT组治疗3d后的SBP、DBP、MAP、尿量和SpO2均显著高于对照组（均P〈0．05）。两组患者治疗3d后的超敏C反应蛋白（hs—CRP）、降钙素原（PCT）、血肌酐（SCr）、血尿素氮（BUN）和中性粒细胞百分比（N％）均显著低于治疗前（均P〈0．05）；CRRT组治疗3d后的hs—CRP、PCT、SCr、BUN和N％均显著低于对照组（均P〈0．05）。两组患者治疗7d的病死率差异无显著性（P〉0．05）；CRRT组治疗28d时病死率显著低于对照组（χ^2=4．9333，P=0，0263〈0．05）。CRRT治疗延迟时间越长，患者28d死亡的可能性越大。选择36h为截断点时，灵敏度为40．71％，特异度为91．15％。结论对于脓毒血症合并AKI患者早期行CRRT治疗及专科护理，可有效消除炎症介质，改善肾功能，提高患者存活率。Objective To investigate the influence and nursing of CRRT in treating septicopyemia with AKI. Methods 92 patients with septicopyemia with AKI in our hospital from January 2012 to July 2014 were selected as study objects. They were divided into CRRT group and control group, according to treatment method. CRRT group was treated CRRT and specific nursing. Control group was treated conventional medical treatment and nursing. The vital signs, serum indexes before and 3 days after treatment, nursing effect and fatality rate after 7 days and 28 days were observed. Results SBP, DBP, MAP, SpO2 of the two groups after 3 dayst treatment were better than before treatment（P〈0.05）. SBP, DBP,MAP, RUV and SpO2 3 days later of CRRT group were obviously higher than that of control group （P〈0.05）. hsCRP,PCT, SCr,BUN and N% of the two groups were obviously lower than that before treatment （P〈 0.05）. hsCRP, PCT, SCr, BUN and N% of CRRT group were obviously lower than that of control group after 3 days＇ treatment（P〈0.05）. Fatality rate after 7 days of the two groups had no significant difference（P〉0.05）. Fatality rate after 28 days of CRRT group was obviously lower than that of control group, χ^2 =4. 9333,P=0. 0263〈0.05. The longer the delay time, the higher the fatality rate after 28 days. 36 h were chosen as cut-off point. The sensitivity was 40.71% and the specificity was 91.15%. Conclusin Using CRRT and specific nursing in treating septicopyemia with AKI can effectively eliminate inflammation medium, improve renal function and increase patient＇ survival rate.

关 键 词：脓毒血症 急性肾损伤 连续性肾脏替代治疗 护理 

分 类 号：R515.3[医药卫生—内科学] R692.5[医药卫生—临床医学]