脓毒血症合并急性肾损伤患者经CRRT联合血液灌注疗法治疗的疗效评价  

Efficacy evaluation of CRRT combined with blood perfusion therapy in patients with sepsis and acute kidney injury

作　　者：焦相赟 吴金海[1] 李翠英[1] 李想 JIAO Xiang-yun;WU Jin-hai;LI Cui-ying;LI Xiang

机构地区：[1]南阳市第一人民医院急诊医学科,河南南阳473400

出　　处：《中国疗养医学》2023年第7期759-762,共4页Chinese Journal of Convalescent Medicine

基　　金：河南省医学科技攻关计划项目(LHGJ20210972)。

摘　　要：目的探究脓毒血症合并急性肾损伤(AKI)患者经连续性肾脏替代疗法(CRRT)联合血液灌注疗法治疗的疗效,为进一步提高临床治疗效果提供参考。方法选取2021年3月至2022年3月南阳市第一人民医院收治的110例脓毒血症合并AKI患者,根据治疗方案不同分为观察组(n=55)、对照组(n=55),对比两组患者肾功能恢复情况[尿素氮(BUN)、肌酐(SCr)、α1-微球蛋白(α1-MG)]、凝血功能[凝血酶原时间(PT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)]、氧合指数(OI)、炎性因子[超敏C反应蛋白(hs-CRP)、肝型脂肪酸结合蛋白(L-FABP)、高迁移率族蛋白B1(HMGB1)]水平、急性生理功能和慢性健康状况Ⅱ评分系统(APACHEⅡ)评分、感染相关器官功能衰竭(SOFA)评分、尿量恢复时间及心血管事件发生情况,并随访30 d,比较两组生存情况。结果治疗7 d后观察组BUN、SCr低于对照组,α1-MG高于对照组(P<0.05);观察组APTT、PT低于对照组,FIB、OI值高于对照组(P<0.05);观察组血清hs-CRP、L-FABP、HMGB1水平低于对照组(P<0.05);观察组APACHEⅡ评分、SOFA评分均低于对照组(P<0.05);观察组尿量恢复时间短于对照组(P<0.05);两组心血管事件发生率对比,差异无统计学意义(P>0.05);观察组30 d病死率10.91%(6/55)低于对照组25.45%(14/55),差异有统计学意义(P<0.05)。结论CRRT联合血液灌注疗法治疗脓毒血症合并AKI患者,可改善肾功能、凝血功能,缓解炎症状态,促进尿量恢复,治疗效果较优且具有一定安全性。Objective To explore the efficacy of continuous renal replacement therapy(CRRT)combined with blood perfusion therapy in patients with sepsis complicated with acute kidney injury(AKI),so as to provide reference for further improving clinical treatment effectiveness.Methods 110 patients with sepsis complicated with AKI admitted to the First People's Hospital of Nanyang City from March 2021 to March 2022 were selected and divided into an observation group(n=55)and a control group(n=55)based on different treatment plans.The two groups were compared in terms of renal function recovery including blood urea nitrogen(BUN),creatinine(SCr),α1-Microglobulin(α1-MG);coagulation function[prothrombin time(PT),fibrinogen(FIB),activated partial thromboplastin time(APTT)];oxygenation index(OI);inflammatory factors[hypersensitive C-reactive protein(hs-CRP),liver type fatty acid binding protein(L-FABP),high mobility group box1(HMGB1)]levels;acute physiology and chronic health evaluationⅡ(APACHE II)scores;sepsis-related organ failure assessment(SOFA)scores;the recovery time of urine volume and the occurrence of cardiovascular events.They were followed up for 30 days to compare the survival status of the two groups.Results After 7 days of treatment,the BUN and SCr in the observation group were lower than those in the control group,whileα1-MG was higher than that in the control group(P<0.05);The APTT and PT of the observation group were lower than those of the control group,while the FIB and OI values were higher than those of the control group(P<0.05);The serum levels of hs-CRP,L-FABP,and HMGB1 in the observationgroup were lower than those in the control group(P<0.05);The APACHE II score and SOFA score in the observation group were lower than those in the control group(P<0.05);The recovery time of urine volume in the observation group was shorter than that in the control group(P<0.05);There was no statistically significant difference in the incidence of cardiovascular events between the two groups(P>0.05);The 30-day mortality rat

关 键 词：脓毒血症 急性肾损伤 血液灌注 连续性肾脏替代疗法 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]