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连续肾替代治疗加用不同剂量血必净对脓毒症合并急性肾损伤患者的影响
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| 篇名： | 连续肾替代治疗加用不同剂量血必净对脓毒症合并急性肾损伤患者的影响 |
| TITLE： | |
| 摘要： | 目的：观察连续肾替代治疗（CRRT）加用不同剂量血必净对脓毒症合并急性肾损伤（AKI）患者的影响及安全性。方法：选取2012年6月－2015年8月我院ICU的脓毒症合并AKI患者104例。按照随机数字表法将其分为小、中、大剂量组和对照组，各26例。4组患者均给予基础治疗；小剂量组患者给予血必净注射液50 mL加入0.9％氯化钠注射液（NS）100 mL中，ivgtt，bid；中剂量组患者给予血必净注射液100 mL加入NS 100 mL中，ivgtt，bid；大剂量组患者给予血必净注射液100 mL加入NS 100 mL中，ivgtt，qid。4组患者均治疗1周。观察4组患者治疗前后血清白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、和超敏C反应蛋白（hs-CRP）等炎症因子水平，血尿素氮（BUN）、血肌酐（SCr）和胱抑素（CysC）等肾功能指标水平，凝血酶原时间（PT）、部分活化凝血活酶时间（APTT）和纤维蛋白原（Fib）等凝血功能指标水平，急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）、多器官功能障碍评分系统（Marshall）评分，并记录治疗过程中不良反应发生情况。结果：脱落9例后，本研究最终纳入统计的合格病例数95例，小、中、大剂量组和对照组分别为23、24、25、23例。治疗前，4组患者上述指标比较，差异均无统计学意义（P＞0.05）。治疗后，4组患者血清IL-6、TNF-α、CRP、PT、APTT水平和APACEⅡ及Marshall评分均明显降低/缩短，血清BUN、SCr、CysC、Fib水平均明显升高，小、中、大剂量组患者上述指标改善均明显优于对照组，大剂量组明显优于小、中剂量组，差异均有统计学意义（P＜0.05）。4组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：CRRT加用大剂量血必净可显著抑制脓毒症合并AKI患者的炎症反应，改善肾功能和凝血功能，且不增加不良反应发生风险。 |
| ABSTRACT： | OBJECTIVE： To observe effect and safety of continuous renal replacement therapy （CRRT） combined with different doses of xuebijing sepsis patients with acute kidney injury （AKI）. METHODS： One hundred and four patients diagnosed as sepsis complicated with AKI were collected from ICU of our hospital during Jun. 2012 to Aug. 2015. They were divided into small-dose group， medium-dose group， large-dose group and control group according to random number table， with 26 cases in each group. Four groups received routine treatment. Small-dose group was given Xuebijing injection 50 mL added into 0.9％ Sodium chloride injection （NS） 100 mL， ivgtt， bid； medium-dose group was given Xuebijing injection 100 mL added into NS 100 mL， ivgtt， bid； large-dose group was given Xuebijing injection 100 mL added into NS 100 mL， ivgtt， qid. All patients were treated for 1 week. The levels of IL-6， TNF-α and hs-CRP were observed in 4 groups before and after treatment； renal function indexes as BUN， SCr and CysC， blood coagulation function indexes as PT， APTT and Fib were also observed as well as APACHEⅡ score and Marshall score. The occurrence of ADR were recorded during treatment. RESULTS： Ninety-five cases meeting the criteria were finally included in the study after 9 cases withdrew from the study， and there were 23， 24， 25， 23 cases in small-dose group， medium-dose group， large-dose group and control group， respectively. Before treatment， there was no statistical significance in above indexes among 4 groups （P＞0.05）. After treatment， the serum levels of IL-6， TNF-α， CRP， PT and APTT， APACHEⅡ score and Marshall score in 4 groups were all decreased significantly， while the serum levels of BUN， SCr， CysC and Fib were increased significantly； the improvement of above indexes in small-dose group， medium-dose group and large-dose group were all better than in control group， and the large-dose group was significantly better than the small-dose group and medium-dose group， with statistical significance （P＜0.05）. There was no statistical significance in the incidence of ADR among 4 groups （P＞0.05）. CONCLUSIONS： Large-dose xuebijing combined with CRRT can effectively inhibit inflammatory reaction in sepsis patients with AKI， improves renal function and coagulation function， and dose not increase the risk of ADR. |
| 期刊： | 2017年第28卷第8期 |
| 作者： | 姜启栋，张雪梅，伍长学 |
| AUTHORS： | JIANG Qidong，ZHANG Xuemei，WU Changxue |
| 关键字： | 血必净；连续肾脏替代治疗；脓毒症；急性肾损伤；肾功能；凝血功能，安全性 |
| KEYWORDS： | Xuebijing； Continuous renal replacement therapy； Sepsis； Acute kidney injury； Renal function； Coagulation function； Safety |
| 阅读数： | 316 次 |
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