摘要
目的比较在脓毒血症相关的急性肾损伤(AKI)患者中,连续静脉血液透析滤过(CVVHDF)高剂量与常规剂量治疗后患者细胞因子的清除效果。方法选取2014年5月至2016年9月华中科技大学同济医学院附属武汉市第一医院重症监护病房收治的符合纳入标准和排除标准的脓毒症合并AKI患者41例,其中男24例,女17例;平均年龄(40.2±9.6)岁。根据患者透析治疗剂量将患者分为常规剂量组[25 mL/(kg·h),18例]和高剂量组[40 mL/(kg·h),23例]。比较不同透析剂量治疗前后白介素(IL)-6、肿瘤坏死因子-α(TNF-α)、IL-10的变化。结果常规剂量组中8例患者(44.4%)在28 d内死亡,高剂量组中9例(42.9%)死亡。两组患者在年龄、体重指数、急性生理与慢性健康评分(APACHEⅡ)评分、序贯器官功能评价(SOFA)评分、治疗前IL-6、TNF-α、IL-10等差异均未见明显统计学意义(P>0.05)。CVVHDF干预的平均持续时间为常规剂量CVVHDF组5.5 d和高剂量CVVHDF组6.2 d。高透析剂量组的IL-6和TNF-α在24较基线显著降低(P<0.05)。高剂量组CVVHDF治疗滤器出口处IL-6和TNF-α较入口处显著降低(P<0.05)。而常规剂量组中的出口未观察到细胞因子显著下降。IL-10在两组患者治疗前后比较差异均无统计学意义(P>0.05)。结论在脓毒症诱导的AKI患者中,与需要RRT治疗的的常规CVVHDF剂量相比,高CVVHDF剂量增加一些炎性细胞因子的清除,但并不改善患者临床结果。
Objective To compare the survival and cytokine clearance of patients with acute renal injury associated with sepsis, continuous venous hemodialysis, high dose and conventional dose. Methods Forty - one patients with sepsis combined with AKI were enrolled in the ICU Hospital of Wuhan NO.1 Hospital from May 2014 to September 2016. Among them, 24 males and 17 females ,had an average age of 40.2 ± 9.6 year old. Patients were divided into two groups according to the patient＇s dialysis dose： conventional dose group（2S mL/[kg.h], n=lS） and high dose group（40 mL/[kg·h], n=23）. Compared the IL-6, TNF-α and IL-10 levels before and after treatment. Results Eight patients （44.4%） died in 28 days in the conventional dose group and 9 （42.9%） in the high dose group died. There was no significant difference in age, body mass index, APACHE II score, SOFA score, IL-6, TNF-a and IL-10 levels before treatment （P〉 0.05）. The average duration of CVVHDF intervention was 5.5 days for the conventional dose CVVHDF group and 6.2 days for the high dose CVVHDF group. The levels of IL-6 and TNF-α in the hyperdialysis dose group were significantly lower at 24 h Compare to the baseline（P〈0.05）, and the difference was statistically significant. This was not observed in the conventional dose group. IL-6 and TNF-α levels were significantly lower in the high-dose group at the outlet of the CVVHDF treatment filterw when compare to the inlet （P〈0.05）, and the difference was statistically significant. While this was not observed in the conventional dose group. There was no significant difference in IL-10 between the two groups before and after treatment （P〉 0.05）. Condution High CVVHDF doses increase the clearance of some inflammatory cytokines compared with the conventional CVVHDF doses, in patients with acute renal injury associated with sepsis require RRT treatment, but the clinical outcome did not improved.
作者
卢蓉
尚小珂
万微波
邓巍
汪超阳
范学朋
LU Rong;SHANG Xiao-ke;WAN Wei-bo;DENG Wei;WANG Chao-yang;FAN Xue-peng(Department of ICU,Wuhan NO.1 Hospital,Tongji Medical College,Huazhong University of Science and Technology,wuhan 430022,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2018年第10期940-944,共5页
Chinese Journal of Practical Internal Medicine
基金
湖北省自然科学基金(2013CFC114)
武汉市中青年医学骨干人才培养专项基金(2016)
