连续肾脏替代疗法不同剂量选择治疗重症肺炎合并急性肾损伤  

Clinical effects of different dosage of CRRT on patients with severe pneumonia and AKI

作　　者：谢媛[1] 刘子梦[1] 郑粉双[1] 许宗明[2] XIE Yuan;LIU Zimeng;ZHENG Fenshuang;XU Zongming(Yunnan Second People′s Hospital,Kunming 650000,China)

机构地区：[1]云南省第二人民医院,昆明650000 [2]云南省急救中心急救科,昆明650000

出　　处：《实用医学杂志》2018年第21期3598-3602,共5页The Journal of Practical Medicine

摘　　要：目的探讨连续肾脏替代疗法(CRRT)不同剂量选择治疗重症肺炎合并急性肾损伤(AKI)的临床效果。方法按照CRRT剂量不同将70例重症肺炎合并AKI患者分为观察组39例和对照组31例,两组患者均在常规综合治疗基础上给予CRRT治疗,对照组置换液剂量为50 mL/(kg·h),观察组置换液剂量为100 mL/(kg·h),观察两组患者治疗效果。结果两组患者治疗后HR水平比较,差异无统计学意义(P> 0.05);观察组患者治疗后血清CRP水平显著低于对照组,淋巴细胞CD4+/CD8+水平显著高于对照组,差异有统计学意义(P <0.05);两组患者治疗后SCr水平比较,差异无统计学意义(P>0.05);观察组患者治疗后PMN吞噬率和吞噬指数均显著高于对照组,差异有统计学意义(P <0.05);观察组患者治疗后APACHEⅡ评分、SOFA评分均显著低于对照组,差异有统计学意义(P <0.05);观察组患者CRP、SCr清除率显著高于对照组,差异有统计学意义(P <0.05);观察组患者病死率显著低于对照组,肺部阴影吸收良好率和4周出院率显著高于对照组,差异有统计学意义(P <0.05)。结论高剂量CRRT治疗重症肺炎合并AKI效果显著优于低剂量,在清除肌酐、改善免疫功能、增强PMN吞噬功能和改善临床症状方面优势明显。Objective To investigate the clinical effects of different dosage of CRRT(continuous renal replacement therapy)on patients with severe pneumonia and AKI(acute kidney injury).Methods Seventy cases of patients with severe pneumonia and AKI were divided into the experimental group(39 cases)and the control group(31 cases)with different dosage.All the patients were treated by CRRT based on routine comprehensive treatment after admission.The dosage of displacement liquid was 50 mL/(kg·h)and 100 mL/(kg·h)for the control group and experimental group,respectively..The clinical effects were compared.Results There was no significant difference on the level of HR after treatment between the two groups(P>0.05).The level of CRP after treatment in the experimental group was lower than that in the control group,the level of CD4+/CD8+after treatment in the experimental group was higher than that in the control group(P<0.05).There was no significant difference on the level of SCr after treatment between the two groups(P>0.05).The rate of PMN phagocytic and the level of phagocytic count after treatment in the experimental group were higher than those in the control group(P<0.05,respectively).The level of APACHEⅡscore and SOFAC score after treatment in the experimental group were lower than those in the control group(P<0.05,respectively).The clearance rate of CRP,SCr in the experimental group were higher than those in the control group(P<0.05,respectively).The mortality in the experimental group was lower than that in the control group(P<0.05).The lung shadow absorption rate and hospital discharge rate for 4 month in the experimental group were higher than those in the control group(P<0.05).Conclusion High dosage of CRRT has better clinical effects on patients with severe pneumonia and AKI,with obvious advantages in clearing creatinine,enhancing neutrophil phagocytosis and improving immune function and clinical symptoms.

关 键 词：重症肺炎 急性肾损伤 连续肾脏替代疗法 剂量 免疫功能 

分 类 号：R563.1[医药卫生—呼吸系统] R692[医药卫生—内科学]