连续性肾脏替代治疗对重症急性肾功能衰竭患者肾功能、血流动力学指标及血清炎性因子水平的影响  

Effects of continuous renal replacement therapy on renal function,hemodynamic parameters and inflammatory factors in patients with severe acute renal failure

作　　者：齐路 刘瑞芳 王聪梅 耿玉安 许智晶 师延刚 苏世琼 Qi Lu;Liu Ruifang;Wang Congmei;Geng Yu’an;Xu Zhijing;Shi Yangang;Su Shiqiong(Department of Critical Medicine,the Third People’s Hospital Directly Under Henan Province,Zhengzhou 450000,China)

机构地区：[1]河南省直第三人民医院重症医学科,郑州450000

出　　处：《中国实用医刊》2020年第7期29-33,共5页Chinese Journal of Practical Medicine

基　　金：2018年度河南省医学科技攻关计划项目(2018020580)。

摘　　要：目的观察连续性肾脏替代治疗对重症急性肾功能衰竭患者肾功能、血流动力学指标及血清炎性因子水平的影响。方法纳入2015年3月至2018年3月河南省直第三人民医院收治的124例重症急性肾功能衰竭患者为研究对象,采用随机数字表法分为对照组与观察组,每组62例。对照组采用间歇性血液透析疗法治疗,观察组患者采用连续性肾脏代替疗法。比较两组患者临床疗效,治疗前后肾功能(尿素氮、肌酐、胆碱酯酶)、血流动力学指标[氧合指数、心率、平均动脉压(MAP)]、炎性因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血清淀粉样蛋白(SAA)]水平变化情况,以及不良反应发生率。结果观察组患者治疗总有效率为93.55%(58/62),高于对照组的75.81%(47/62),P<0.05。治疗后,两组患者尿素氮、肌酐均低于治疗前,且观察组低于对照组(P<0.05);两组治疗后胆碱酯酶均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组患者氧合指数、MAP均较治疗前升高,且观察组高于对照组(P<0.05);两组心率均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。两组患者血清IL-6、TNF-α、SAA水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组患者治疗期间心血管事件发生率为4.84%(3/62),低于对照组的25.81%(16/62),差异有统计学意义(P<0.05)。结论连续性肾脏替代治疗重症急性肾功能衰竭安全有效,可更有效地促进患者肾功能恢复,维持血流动力学稳定,改善微炎症状态。ObjectiveTo observe the effects of continuous renal replacement therapy on renal function, hemodynamic parameters and inflammatory factors in patients with severe acute renal failure.MethodsA total of 124 patients with severe acute renal failure admitted to the Third People’s Hospital Directly Under Henan Province from March 2015 to March 2018 were enrolled in the study. The selected patients were divided into observation group and control group according to the random number table method, with 62 cases in each group. Patients in the control group were given intermittent hemodialysis, while patients in the observation group were treated by continuous renal replacement therapy. The clinical efficacy, renal function (blood urea nitrogen, creatinine, cholinesterase), hemodynamic parameters, including oxygenation index, heart rate, mean arterial pressure (MAP), and preoperative and postoperative inflammatory factors, such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), serum amyloid protein (SAA) , and incidence of adverse reactions were compared between the two groups.ResultsThe total effective rate of treatment in observation group was 93.55% (58/62), higher than the 75.81% (47/62) in control group (P<0.05). After treatment, the levels of blood urea nitrogen and creatinine in the two groups were lower than those before treatment, and the indexes in observation group were lower than those in control group (P<0.05);while the postoperative levels of cholinesterase in both groups were higher than preoperative levels, and the index in observation group was higher than that in control group (P<0.05). The oxygenation index and MAP in the two groups increased after treatment, and the indexes in observation group were higher than those in control group (P<0.05);while the heart rates decreased in both groups after treatment, and the index in observation group was lower than that in control group after treatment (P<0.05). After treatment, the serum levels of IL-6, TNF-α and SAA in the two groups decreased, comp

关 键 词：急性肾功能衰竭 连续性肾脏替代 尿素氮 肌酐 胆碱酯酶 微炎症状态 血流动力学 

分 类 号：R692[医药卫生—泌尿科学]