间歇性高容量血液滤过对脓毒症合并急性肾损伤患者炎性介质及血流动力学的影响  

Effects of intermittent high-volume Hemofiltration on Inflammatory Mediators and Hemodynamics in Sepsis Patients with acute renal Injury

作　　者：叶红 YE Hong(Department of Nephrology,Xinyang People's Hospital,Xinyang Henan 464100,China)

机构地区：[1]信阳市人民医院肾内科,河南信阳464100

出　　处：《临床研究》2022年第12期56-59,共4页Clinical Research

摘　　要：目的 探讨间歇性高容量血液滤过对脓毒症合并急性肾损伤(AKI)患者炎性介质及血流动力学的影响,以期改善脓毒症合并AKI患者临床预后,降低病死风险。方法 选取2017年8月至2018年10月信阳市人民医院收治的60例脓毒症合并AKI患者为研究对象,按照完全随机分组法将60例患者分为两组,各30例。两组入住重症监护室(ICU)后均给予常规对症治疗,对照组采用间歇性血液透析治疗,观察组采用间歇性高容量血液滤过治疗。治疗前、治疗1周时评估两组患者肾功能指标[血肌酐(Scr)、尿素氮(BUN)、β2微球蛋白(β2-MG)、血尿酸(UA)]、炎性指标[白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、血小板计数(PCT)]与血流动力学参数[平均动脉压(MAP)、心率(HR)、心脏指数(CI)]水平改善情况。结果 治疗1周,两组Scr、BUN、β2-MG、UA水平均降低,且观察组低于对照组,差异有统计学意义(P <0.05);治疗1周,两组IL-6、IL-17、TNF-α、PCT水平均降低,且观察组低于对照组,差异有统计学意义(P <0.05);治疗1周,两组MAP、CI均升高,HR均降低,且观察组改善优于对照组,差异有统计学意义(P <0.05)。结论 脓毒症合并AKI患者采用间歇性高容量血液滤治疗更有利于减轻全身炎症反应,改善血流动力学,有利于肾功能恢复。Objective To investigate the effects of intermittent high-volume hemofiltration on inflammatory mediators and hemodynamics in sepsis patients with acute renal injury(AKI),so as to improve the clinical prognosis of sepsis patients with AKI and reduce the risk of death.Methods A total of 60 patients with sepsis and AKI admitted to Xinyang People's Hospital from August 2017 to October 2018 were selected as the research object,and 60 patients were divided into two groups according to the complete random grouping method,30 patients in each group.Both groups were treated with conventional symptomatic treatment after being admitted to the intensive care unit(ICU).The control group was treated with intermittent hemodialysis,and the observation group was treated with intermittent high-volume hemofiltration. The renal function indexes [blood creatinine (Scr), urea nitrogen (BUN), β2 micro globulin (β2-MG), blood uric acid (UA)], inflammatory indicators [interleukin-6 (IL- 6), interleukin-17 (IL-17), tumor necrosis factor-α (TNF- α), the improvement of platelet count (PCT) and hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR), heart index (CI)] were compared. Results After 1 week of treatment, the levels of Scr, BUN, β2-MG and UA in the observation group were significantly lower than those in the control group (P < 0.05);After one week treatment, the levels of IL-6, IL-17, TNF-α and PCT in both groups were decreased, and the levels of MAP, CI and HR in the observation group were significantly lower than those in the control group (P < 0.05), and the improvement of the observation group was better than the control group, the difference was statistically significant (P < 0.05). Conclusion Intermittent high-volume hemofiltration is more beneficial to reduce systemic inflammatory reaction, improve hemodynamics and restore renal function in patients with sepsis and AKI.

关 键 词：脓毒症 急性肾损伤 血液透析 高容量血液滤过 炎性介质 血流动力学 肾功能 

分 类 号：R692.5[医药卫生—泌尿科学]