不同 CRRT 治疗剂量对严重脓毒症患者细胞因子清除及预后的影响

摘要

Objective:To explore the influence of different therapeutic doses of continuous renal replacement therapy(CRRT)on cytokines scavenging and prognosis of severe sepsis patients. Methods:Selected 80 inpatients receiving CRRT for severe sepsis in ICU of our hospital from January 2014 to October 2015 as research objects,randomly divided them into group A and group B. Group A patients adopted treatment of high dose referring to percolate dose≥35 ml/(kg·h),while group B adopted treatment of low dose referring to percolate dose ≤35 ml/(kg·h). Before the treatment and 48 hours after the treatment,collected blood sample for routine examination,obtained indicators of blood gas,hepatic and renal function and cytokines IL - 1β,IL - 6,IL -10 and TNF - α of patients in the two groups,and simultaneously recorded chronic health condition score(APACHE Ⅱscore)condition. Results:Compared the heart rate,lactic acid,creatinine,urea nitrogen,ALT and APACHE Ⅱscores 48 hours after CRRT,the reduced value of group A was higher than that of group B;the reduced values of cytokines IL - 1β,IL - 6 and TNF - α of group A were higher than those of group B. The difference in 28 d survival rates of patients in the two groups was of no statistical significance,but the mechanical ventilation time and ICU stay of group A were shorter than those of group B. Conclusion:CRRT on severe sepsis patients can effectively clear cytokines,and shorten mechanical ventilation and ICU stay.%目的：探讨连续性血液滤过（CRRT）不同治疗剂量对严重脓毒症患者细胞因子清除及预后的影响。方法：选取2014年1月~2015年10月我院 ICU 收住院因严重脓毒症患者行 CRRT 治疗的80例患者作为研究对象，随机分为 A 组和 B 组，A 组患者采用高剂量即滤出液剂量≥35 ml／（kg·h）治疗，B 组采用低剂量即滤出液量＜35 ml／（kg·h）治疗。治疗前及 CRRT 治疗48 h 后采集血样常规送检获得两组患者血气、肝肾功能以及细胞因子 IL -1β，IL -6，IL -10，TNF -α等指标，同时记录慢性健康状况评分（APACHE Ⅱ评分）情况。结果：CRRT 治疗48 h 后，心率、乳酸、肌酐、尿素氮以及 ALT 和 APACHE Ⅱ评分比较，A 组的降低值高于 B 组；细胞因子 IL -1β，IL -6，TNF -α的降低值 A 组高于 B 组。两组患者的28 d 生存率比较差异无统计学意义，但 A 组患者机械通气时间及 ICU 住院时间少于 B 组患者。结论：严重脓毒症患者 CRRT 能有效地清除细胞因子，减少机械通气及 ICU 住院时间。