不同比例前后稀释的置换液在CRRT治疗脓毒血症患者中的应用研究  

Application of Different Proportions of Diluted Fluid Before and After Treatment in Patients with Sepsis Treated with CRRT

作　　者：杨旭 王君艳[2] 白栓成[3] YANG Xu;WANG Jun-yan;BAI Shuan-cheng(Graduate School of Baotou Medical College, Baotou,Inner Mongolia, 014040 China;ICU, Baotou Central Hospital, Baotou,Inner Mongolia, 014040 China;Department of Anesthesiology, Baotou Central Hospital, Baotou,Inner Mongoli-a, 014040 China)

机构地区：[1]内蒙古包头医学院研究生学院,内蒙古包头014040 [2]内蒙古包头市中心医院ICU,内蒙古包头014040 [3]内蒙古包头市中心医院麻醉科,内蒙古包头014040

出　　处：《系统医学》2019年第17期57-60,共4页Systems Medicine

摘　　要：目的该研究旨在探讨不同比例前后稀释的置换液在CRRT治疗脓毒血症患者中的应用研究,为脓毒症的临床治疗提供理论依据。方法选取包头市中心医院重症医学科(ICU)2017年1月—2018年12月收治的24例脓毒症患者作为研究对象。根据随机分配原则,将所有入组患者分为100%前稀释组(A组)、50%前稀释+50%后稀释组(B组)和100%后稀释组(C组)3组。留取CRRT治疗前的血液和血清标本作为基线对照,在CRRT治疗后的12 h和72 h再分别留取标本,检测血常规、生化以及血气。记录PLT和PCT浓度并计算患者BUN/Scr和PaO2/FiO2比值,APACHE II评分根据评分表进行打分并记录。结果 3组患者治疗12 h后BUN/Scr比值和APACHE II评分开始降低,PCT和PaO2/FiO2浓度升高,PLT浓度持续下降。治疗效果以C组更明显,72 h后与12 h相比PCT浓度、BUN/Scr比值、APACHE II评分显著降低,分别为[(9.27±0.43)ng/mL vs (31.88±0.96)ng/mL;(15.78±0.43) vs (19.87±0.99);(12.88±0.77)分vs (14.42±1.18)分], PaO2/FiO2浓度明显升高[(358.13±21.75) vs (188.0±11.19)],PLT浓度继续降低[(33.36±4.85)×10^9/L vs (49.33±7.71)×10^9/L],差异有统计学意义(P<0.05)。结论 100%前稀释法、100%后稀释法和50%前稀释+50%后稀释法对脓毒症患者的治疗均有效,但100%后稀释法相比100%前稀释法和50%前稀释+50%后稀释法滤过效率更高,效果更好。Objective The purpose of this study was to investigate the application of different proportions of pre- and post-diluted replacement fluids in patients with sepsis treated with CRRT, and to provide a theoretical basis for clinical treatment of sepsis. Methods 24 patients with sepsis admitted to the Department of Critical Care Medicine (ICU) of Baotou Central Hospital from January 2017 to December 2018 were selected as subjects. According to the principle of random assignment, all enrolled patients were divided into three groups: 100% pre-dilution group (group A), 50% pre-dilution+50% post-dilution group (group B) and 100% post-dilution group (group C). Blood and serum samples before CRRT treatment were used as baseline controls, and samples were taken at 12 and 72 h after CRRT treatment to detect blood routine, biochemistry, and blood gas. PLT and PCT concentrations were recorded and patient BUN/Scr and PaO2/ FiO2 ratios were calculated. APACHE II scores were scored and recorded according to the score table. Results After 12 hours of treatment, the BUN/Scr ratio and the APACHE II score began to decrease, the PCT and PaO2/FiO2 concentra-tions increased, and the PLT concentration continued to decrease. The therapeutic effect was more obvious in group C. Compared with 12 h, the PCT concentration, BUN/Scr ratio and APACHE II score were significantly lower after 72 h,respectively [(9.27 ±0.43)ng/mL vs (31.88±0.96)ng/mL;(15.78±0.43) vs(19.87±0.99);(12.88±0.77) points vs (14.42±1.18)points, PaO2/FiO2 concentration in-creased significantly [(358.13±21.75) vs (188.0±11.19)], PLT concentration continued decrease to [(33.36±4.85)×109 /L vs (49.33±7.71)×109 /L], and the difference was statistically significant (P<0.05). Conclusion 100% pre-dilution method, 100% post-dilution method and 50% pre-dilution+50% post-dilution method are effective for the treatment of patients with sepsis, but the 100% post-dilution method is compared with 100% pre-dilution method and 50% pre-dilution + 50% post-dilution method, the dil

关 键 词：脓毒症 连续肾脏替代疗法(CRRT) 前稀释 后稀释 

分 类 号：R4[医药卫生—临床医学]