早期连续性血液净化对老年重症脓毒血症急性肾损伤患者血流动力学、炎症反应及细胞黏附分子-1水平的影响  

Effects of early continuous blood purification on hemodynamics,inflammatory response and cell adhesion molecular-1 level in elderly patients with severe sepsis and acute renal injury

作　　者：吴威 管胜伟 罗中旭 Wu Wei;Guan Sheng wei;Luo Zhongxu(Department of Critical Care Medicine,Zhoukou Hospital of Traditional Chinese Medicine,Zhoukou 466000,China)

机构地区：[1]周口市中医院重症医学科,466000

出　　处：《国际移植与血液净化杂志》2024年第1期9-12,共4页International Journal of Transplantation and Hemopurification

摘　　要：目的探讨早期连续性血液净化对老年重症脓毒血症急性肾损伤(AKI)患者血流动力学、炎症反应及细胞黏附分子-1水平的影响。方法选取我科2021年1月至2022年6月期间收治的94例老年重症脓毒血症AKI患者作为研究对象,随机分为两组,常规组47例给予常规基础治疗,血液净化组47例给予联合早期连续性血液净化治疗。比较两组患者血流动力学指标、炎症反应水平、血清学指标以及不良结局。结果血液净化组中心静脉压、心输出量指数、外周血管阻力指数高于常规组,肺血管通透性指数、血管外肺水指数低于常规组(P<0.05)。血液净化组C反应蛋白、白细胞介素-6、降钙素原、肿瘤坏死因子-α水平低于常规组(P<0.05)。血液净化组细胞黏附分子-1水平低于常规组,胆碱酯酶水平高于常规组(P<0.05)。血液净化组不良结局总发生率(6.38%)低于常规组(23.40%)(P<0.05)。结论早期连续性血液净化应用于老年重症脓毒血症AKI患者有助于改善血流动力学,减轻炎症反应,调节细胞黏附分子-1、胆碱酯酶水平,降低不良结局发生率。Objective To investigate the effects of early continuous blood purification on hemodynamics,inflammatory reaction and cell adhesion molecule-1(ICAM-1)level in elderly patients with severe sepsis and acute kidney injury(AKI).Methods A total of 94 elderly patients with severe sepsis and AKI in our department were selected as the study subjects from January 2021 to June 2022,and randomly divided into two groups.47 patients in the conventional group were treated with conventional basic therapy.47 patients in the blood purification group were treated with early continuous blood purification.The hemodynamic indexes,inflammatory reaction levels,serological indexes and adverse outcomes of the two groups were compared.Results The levels of CVP,CI and SVRI in the blood purification group were higher than those in the routine group,and the levels of EVLWI and PVPI in the blood purification group were lower than those in the routine group(P<0.05).The level of CRP,IL-6,PCT,TNF-αin blood purification group was lower than those of routine group(P<0.05).The level of ICAM-1 in blood purification group was lower than that in routine group,and the level of CHE in blood purification group was higher than that in routine group(P<0.05).The total incidence of adverse outcomes in the blood purification group(6.38%)was lower than that in the routine group(23.40%)(P<0.05).Conclusion The application of early continuous blood purification in elderly patients with severe sepsis and AKI can improve hemodynamics,reduce inflammatory reaction,regulate the expression of ICAM-1 and CHE,and reduce the incidence of adverse outcomes.

关 键 词：脓毒血症 急性肾损伤 连续性血液净化 炎症反应 细胞黏附分子-1 

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