基于单中心的早期CRRT治疗在严重腹腔感染中的前瞻对照研究  

Early Continuous Renal Replacement Therapy( CRRT) in the Treatment of Severe Abdominal Infections-A Prospective Controlled Study of Single-center

作　　者：吴媛[1] 王小闯[1] 王利[1] 党双锁[2] Wu Yuan;Wang Xiaochuang;Wang Li(Department of Critical Care Medicine,The Second Affiliated Hospital of Xi′an Jiaotong University,Shaanxi 710004,China)

机构地区：[1]西安交通大学第二附属医院重症医学科,710004 [2]西安交通大学第二附属医院感染科,710004

出　　处：《医学研究杂志》2019年第10期48-52,共5页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81670049);中央高校基本科研业务费专项资金资助项目(xjj2015018);西安交通大学第二附属医院人才培养专项科研基金资助项目[RC(XM)201603]

摘　　要：目的探讨早期连续性血液滤过(CRRT)治疗对严重腹腔感染患者炎性因子及细胞免疫水平的影响及其临床价值。方法将124例严重腹腔感染的患者采用数字表法随机分为常规治疗组及CRRT治疗组,常规治疗组患者给予常规集束化治疗措施;CRRT治疗组在常规集束化治疗基础上加用连续性静脉-静脉血液滤过(CVVH)治疗模式。检测降钙素原(PCT)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)水平及血T淋巴细胞亚群比例;记录两组患者治疗前、治疗7天时的急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭(SOFA)评分、ICU住院天数(天)及28天病死率。结果两组患者治疗前血清PCT、IL-6、IL-10、TNF-α、CD3+及CD4+细胞组间比较差异均无统计学意义;而随着治疗时间延长,两组患者PCT、IL-6、IL-10、TNF-α均呈逐渐下降趋势;CD3+、CD4+比例呈逐渐升高趋势,且CRRT组与常规治疗组间比较,差异有统计意义(P<0.05)。CRRT治疗组患者治疗7天时SOFA评分、APACHEⅡ评分及ICU住院天数明显低于常规治疗组(P均<0.05),两组患者28天病死率差异无统计学意义(P>0.05)。结论严重腹腔感染在早期行CRRT治疗与常规治疗比较,可清除患者体内过高的炎性介质,恢复细胞免疫稳态,为综合治疗提供了时机和条件。Objective To investigate the effect and clinical value of early continuous renal replacement therapy(CRRT)on inflammatory factors and cellular immunity in patients with severe abdominal infection.Methods Totally 124 patients with severe abdominal infection admitted to the Department of Critical Care Medicine from January 2012 to September 2018 were selected as subjects.They were divided into routine cluster treatment group and CRRT treatment group by random number table.Patients in routine treatment group were given routine cluster therapy,while patients in the CRRT treatment group were given continuous venous-venous hemofiltration(CVVH)treatment mode on the basis of routine cluster therapy.The levels of procalcitonin(PCT),interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)were detected by enzyme-linked immunosorbent assay(ELISA).The proportion of blood T lymphocyte subsets was detected by flow cytometry.The acute physiology and chronic health score(APACHEⅡ),sequential organ failure(SOFA)scores,and ICU hospitalization days of the two groups before treatment and after7 days treatment and 28-day mortality were recorded(days).Results There was no significant difference in the proportion of PCT,IL-6,IL-10,TNF-α,CD3+and CD4+cells between the two groups before treatment.However,with the prolonged treatment time,PCT,IL-6,IL-10,TNF-αshowed a gradual decline trend in both groups;the proportion of CD3+and CD4+increased gradually,and there was statistical difference when compared between groups.After 7 days of treatment in the CRRT group,the SOFA score,APACHEⅡscore,and ICU hospital stay were significantly lower than those in the conventional treatment group(P<0.05).There was no significant difference in 28-day mortality rate between the CRRT treatment group and the routine cluster treatment group(P>0.05).Conclusion CRRT treatment can significantly clear the excessive inflammatory mediators and restore the cellular immune homeostasis compared with the routine cluster treatment,and could provid

关 键 词：腹腔感染 血液滤过治疗 炎性因子 细胞免疫 重症监护病房 

分 类 号：R5[医药卫生—内科学]