脓毒症急性肾损伤患者血液净化时机选择对治疗期间微循环系统的影响研究  

Effect of Blood Purification Timing on Microcirculatory System during Treatment in Patients with Acute Kidney Injury Caused by Sepsis

作　　者：谢谦[1] 生娣[1] 廖光冲[1] 陈健[1] 张岩鹏[1] XIE Qian;SHENG Di;LIAO Guang-chong;CHEN Jian;ZHANG Yan-peng(Department ofICU,Affiliated Chinese Medicine Hospital ofXinjiang Medical University,Urumqi,Xinjiang,830000,China)

机构地区：[1]新疆医科大学附属中医医院重症医学科

出　　处：《现代生物医学进展》2019年第11期2129-2132,共4页Progress in Modern Biomedicine

基　　金：新疆维吾尔自治区自然科学基金项目(2014201A325)

摘　　要：目的:探究脓毒症急性肾损伤患者血液净化时机选择对治疗期间微循环系统的影响。方法:选取2016年2月~2017年2月期间来我院治疗的脓毒症急性肾损伤患者200例作为研究对象,依据急性肾损伤的诊断和分级(RIFLE)标准将脓毒症急性肾损伤患者分为1期(A组,n=56)、2期(B组,n=70)、3期(C组,n=74),所有患者皆采取连续性肾脏替代疗法。观察不同时期治疗前后微循环的变化。结果:三组脓毒症急性肾损伤患者在性别、年龄、空腹血糖浓度、急性生理功能和慢性健康状况(APACHE)评分、体温、心率指标上差异无统计学意义(P>0.05);治疗后,A组患者微血管流动指数低于B组和C组,而灌注血管比例、灌注血管密度及总血管密度显著高于B组和C组(P<0.05);A组患者血液流态积分、襻周状态积分、管襻形态积分及总积分显著低于B组和C组(P<0.05),而襻顶血管直径显著大于B组和C组(P<0.05)。结论:在RLFLE诊断标准1期对脓毒症急性肾损伤患者实施血液净化,可以明显地改善治疗效果,促进微循环系统的恢复。Objective: To explore the effect of blood purification timing on the microcirculatory system during treatment in patients with acute kidney injury caused by sepsis. Methods: A total of 200 patients with acute kidney injury caused by sepsis, who were treated in Affiliated Chinese Medicine Hospital of Xinjiang Medical University from February 2016 to February 2017 were chosen as study subjects. According to the criteria of RIFLE, the patients with acute kidney injury caused by sepsis were divided into stage 1(group A, n=56), stage 2(group B, n=70), and stage 3(group C, n=74). All patients were treated with continuous renal replacement therapy(CRRT).The changes of microcirculation before and after treatment were observed. Results: There were no significant differences in sex, age, fasting blood glucose, acute physiology and chronic health evaluation(APACHE) score, body temperature and heart rate of the patients with acute kidney injury caused by sepsis among the three groups(P>0.05). After treatment, the microvascular flow index in group A was significantly lower than that in group B and group C(P<0.05), while the proportion of perfused vessels, the perfusion vessel density and the total vascular density was significantly higher than that in group B and group C(P<0.05). After treatment, the scores of blood flow state,loop weeks status, pipe loop integral and the total score in group A were significantly lower than those in group B and group C(P<0.05),while the diameter of the dome blood vessel was significantly larger than that in group B and group C(P<0.05). Conclusions: In the stage1 of the RLFLE diagnostic criteria, blood purification can significantly improve the treatment effect and promote the recovery of microcirculation system in the patients with acute kidney injury caused by sepsis.

关 键 词：脓毒症 急性肾损伤 连续性肾脏替代疗法 血液净化时机 微循环 

分 类 号：R631.2[医药卫生—外科学] R692[医药卫生—临床医学]