24 h内CRRT对急性脓毒症患者液体平衡、机体免疫功能和近期预后的影响  

Impact of CRRT within 24 h on fluid balance,body immune function and short-term prognosis in patients with acute sepsis

作　　者：刘启光 谭紫君 张磊云 LIU Qi-guang;TAN Zi-jun;ZHANG Lei-yun(Dongguan Donghua Hospital,Dongguan 523000,China)

机构地区：[1]东莞东华医院,523000 [2]东莞市寮步镇社区卫生服务中心,523000

出　　处：《中国现代药物应用》2025年第4期63-66,共4页Chinese Journal of Modern Drug Application

摘　　要：目的探究24 h内连续性肾脏替代疗法(CRRT)对急性脓毒症患者液体平衡、机体免疫功能和近期预后的影响。方法回顾性分析急诊重症监护室(EICU)收治的112例急性脓毒症患者的临床资料,根据患者入院24 h内是否行CRRT分为CRRT组(57例)和非CRRT组(55例)。两组均接受常规治疗,CRRT组入院24 h内接受CRRT治疗,非CRRT组入院24 h内不接受CRRT治疗。比较两组液体平衡情况、机体免疫功能、炎症反应和近期预后。结果所有患者均完成3 d治疗,治疗过程中无死亡患者。CRRT组24 h内液体入量、24 h液体出量、24 h超滤量、24 h尿量、24 h液体累积量、24 h液体负平衡率分别为(2533.28±315.24)ml、(2406.15±259.68)ml、(1226.89±415.25)ml、(758.36±135.69)ml、(127.13±44.69)ml、33.33%,非CRRT组分别为(2997.68±356.24)ml、(2126.58±246.58)ml、(1016.58±345.68)ml、(416.58±129.45)ml、(871.10±68.95)ml、12.73%。与非CRRT组相比,CRRT组患者24 h内液体入量、24 h液体累积量更低,24 h液体出量、24 h超滤量、24 h尿量、24 h液体负平衡率更高,差异有统计学意义(P<0.05)。治疗后,CRRT组CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)分别为(59.89±3.91)%、(47.26±4.77)%、(23.15±2.69)%、(2.04±0.34),非CRRT组分别为(53.67±3.18)%、(41.69±4.61)%、(27.54±2.41)%、(1.56±0.37)。治疗后,两组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均较治疗前升高,CD8^(+)较治疗前降低,且CRRT组CD3^(+)、CD4^(+)及CD4^(+)/CD8^(+)均高于非CRRT组,CD8^(+)低于非CRRT组,差异有统计学意义(P<0.05)。治疗后,CRRT组C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)水平分别为(59.26±12.35)mg/L、(6.01±2.58)μg/L、(7.81±1.26)×10~9/L,非CRRT组分别为(71.05±13.25)mg/L、(12.58±3.15)μg/L、(8.69±1.39)×10~9/L。治疗后,两组CRP、PCT、WBC水平均较治疗前降低,且CRRT组CRP、PCT、WBC水平均低于非CRRT组,差异有统计学意义(P<0.05)。与非CRRT组的重症加强护理病房(ICU)住院时间(13.06±3.7Objective To explore the impact of continuous renal replacement therapy(CRRT)within 24 h on fluid balance,body immune function and short-term prognosis in patients with acute sepsis.Methods The clinical data of 112 patients with acute sepsis admitted to the emergency intensive care unit(EICU)were retrospectively analyzed.The patients were divided into CRRT group(57 cases)and non-CRRT group(55 cases)according to whether they received CRRT within 24 h after admission.Both groups received conventional treatment.On this basis,CRRT group received CRRT treatment within 24 h after admission,and non-CRRT group did not receive CRRT treatment within 24 h after admission.The fluid balance,immune function,inflammatory response and short-term prognosis were compared between the two groups.Results All patients completed 3 d of treatment,and no patients died during the treatment.24 h fluid intake,24 h fluid output,24 h ultrafiltration,24 h urine volume,24 h fluid accumulation and 24 h negative fluid balance rate of the CRRT group were(2533.28±315.24)ml,(2406.15±259.68)ml,(1226.89±415.25)ml,(758.36±135.69)ml,(127.13±44.69)ml and 33.33%,and those of non-CRRT group were(2997.68±356.24)ml,(2126.58±246.58)ml,(1016.58±345.68)ml,(416.58±129.45)ml,(871.10±68.95)ml and 12.73%.Compared with non-CRRT group,24 h fluid intake and 24 h fluid accumulation were lower,and 24 h fluid output,24 h ultrafiltration,24 h urine volume and 24 h negative fluid balance rate were higher in CRRT group(P<0.05).After treatment,CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in CRRT group were(59.89±3.91)%,(47.26±4.77)%,(23.15±2.69)%and(2.04±0.34),and those in non-CRRT group were(53.67±3.18)%,(41.69±4.61)%,(27.54±2.41)%and(1.56±0.37).After treatment,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in both groups were higher than those before treatment,and CD8^(+)was lower than that before treatment;CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in CRRT group were higher than those in non-CRRT group;CD8^(+)in CRRT group was lower than that in non-CRRT group;the difference was

关 键 词：急性脓毒症 连续性肾脏替代疗法 液体平衡 机体免疫 预后 

分 类 号：R459.7[医药卫生—急诊医学]