短时与间歇性高容量血液滤过对脓毒症急性肾损伤患者炎症介质及体温的影响  

Effects of short-term and pulsed high volume hemofiltration on inflammatory mediators and body temperature in sepsis patients complicated with acute kidney injury

作　　者：杨杰章 邢巧睿 黄素珍 YANG Jie-zhang;XING Qiao-rui;HUANG Su-zhen(Department of Critical Medicine,Jiangmen People's Hospital,Jiangmen 529000,Guangdong,China)

机构地区：[1]江门市人民医院重症医学科,广东江门529000

出　　处：《广东医学》2020年第3期261-264,共4页Guangdong Medical Journal

摘　　要：目的比较短时高容量血液滤过(STHVHF)与间歇性高容量血液滤过(PHVHF)对脓毒症急性肾损伤(AKI)患者炎症介质及体温的影响。方法选取脓毒症AKI患者60例的临床资料进行回顾性分析,按治疗方式分为STHVHF组30例和PHVHF组30例。所有患者均按国际脓毒症诊疗指南处理,STHVHF组每天行8 h高容量血液滤过治疗,PHVHF组每天行8 h高容量血液+16 h连续性血液滤过治疗。比较两组患者治疗0、8、16、24 h体温变化;比较第1、3、7天白细胞(WBC)、血肌酐(Scr)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平及APACHEⅡ评分的变化。结果治疗3 d后两组的WBC、Scr、IL-6、TNF-α和APACHEⅡ评分低于治疗前,差异有统计学意义(P<0.05);PHVHF组治疗7 d的IL-6、TNF-α及APACHEⅡ评分低于STHVHF组,差异有统计学意义(P<0.05);PHVHF组第16、24 h体温低于STHVHF组,差异有统计学意义(P<0.05)。结论PHVHF治疗更有效降低炎症介质水平及体温。Objective To compare the effects of short-term high volume hemofiltration(STHVHF)and pulsed high volume hemofiltration(PHVHF)on inflammatory mediators and body temperature in patients with septic acute kidney injury(AKI).Methods Clinical data of 60 patients with septic AKI were retrospectively analyzed,and were divided into the STHVHF group and the PHVHF group.All patients were treated by the international guidelines for the management of sepsis.STHVHF group receiving 8-hour high-volume hemofiltration daily and PHVHF group receiving 8-hour high-volume hemofiltration plus 16-hour continuous hemofiltration daily.The temperature 0 h,8 h,16 h and 24 h after treatment were compared.The white blood cells(WBC),serum creatinine(Scr),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α)levels and APACHEⅡscore were compared 1 d,3 d and 7 d after treatment.Results The WBC,Scr,IL-6,TNF-αand APACHEⅡscore were significantly 3 d after treatment lower than before in both groups(P<0.05).The IL-6,TNF-αand APACHEⅡscore were significantly lower in PHVHF group than STHVHF group 7 d after treatment(P<0.05).Body temperature of PHVHF group was significantly lower than STHVHF group 16 and 24 hours after treatment(P<0.05).Conclusion PHVHF treatment is more effective in reducing the level of inflammatory mediators and body PHVHF is more effective in lowering temperature an reducing systemic inflammatory response.

关 键 词：短时高容量血液滤过 间歇性高容量血液滤过 脓毒症急性肾损伤 炎症介质 体温 

分 类 号：R459.5[医药卫生—治疗学] R692.5[医药卫生—临床医学]