NMRC - DHP 联合 CVVH 对脓毒血症合并急性肾损伤患者 IL -6和 TNF -α水平及器官功能的影响

摘要

Objective To explore the effect of NMRC - DHP combined with continuous venous - venous hemofiltration(CVVH)on lev-els of IL - 6 and TNF - α and impact on organ function in treatment of patients with sepsis complicated with acute renal impairment. Methods A total of 46 patients with sepsis and acute renal impairment were selected and randomly divided into study group and control group(23 cases in each group). Patients in study group were given with NMRC - DHP plus CVVH,and patients in control group were only given with continuous ve-nous - venous hemofiltration(CVVH). The effect of treatment with NMRC plus CVVH in patients with sepsis and acute renal impairment was e-valuated by sequential organ failure assessment(SOFA),oxygenation index(OI),mean arterial pressure(MAP)and changes in serum levels of interleuKin - 6(IL - 6)and tumor necrosis factor - α(TNF - α). Results Serum levels of IL - 6 and IL - 10 in patients of these 2 groups at 24 h and 72 h after treatment had significantly declined in comparison with those before treatment. In patients of study group after treatment,those levels were significantly lower than those of control group. After treatment,OI and MAP in patients of these two groups were significantly increased and Scr was significantly declined. OI and MAP in patients of study group at 24h and 72h after treatment were significantly higher than those of pa-tients in control group,and Scr in study group was significantly lower than that of control group. SOFA scores in patients of these 2 groups at 3d and 7d after treatment were significantly decreased. SOFA scores in study group were significantly lower than those of control group. Conclusion The application of NMRC - DHP combined with CVVH in treatment of patients with sepsis complicated with acute renal impairment can effec-tively remove inflammatory mediators,protect organ function and contribute to the early recovery of their renal function.%目的：探讨中性大孔径树脂血液灌流（NMRC - DHP）联合连续性静脉-静脉滤过（CVVH）对脓毒血症合并急性肾损伤患者白介素6（IL -6）、肿瘤坏死因子α（TNF -α）水平及器官功能的影响。方法选择脓毒血症合并急性肾损伤患者共46例，随机分为研究组和对照组（各23例），研究组行 NMRC - DHP + CVVH 治疗，对照组只进行 CV-VH。通过序贯器官衰竭评分（SOFA）、氧合指数（OI）、平均动脉压（MAP）以及血清白介素6（IL -6）和肿瘤坏死因子α（TNF -α）的水平变化，评价两者在对脓毒血症合并急性肾损伤患者的疗效。结果治疗后24 h 和治疗后72 h，两组血清 IL -6和 IL -10水平较治疗前均出现了显著下降（ P <0.05），研究组治疗后显著低于对照组（ P <0.05）。治疗后两组 OI 和 MAP 出现显著上升，Scr 出现明显下降（ P <0.05），研究组治疗后24 h、72 h 的 OI、MAP 显著高于对照组， Scr 显著低于对照组（ P <0.05）。治疗后3 d 和7 d 两组 SOFA 评分均显著下降，研究组 SOFA 评分显著低于对照组（ P<0.05）。结论脓毒血症合并急性肾损伤患者采用 NMRC - DHP 联合 CVVH 治疗能有效清除炎症介质，保护脏器功能，有助于肾功能的早期恢复。