摘要
目的:探究早期连续性床旁血滤对脓毒性休克合并急性肾损伤疗效及血清内毒素水平的影响。方法:回顾性研究2013年7月-2018年12月潍坊医学院附属医院重症医学科收治脓毒性休克合并急性肾损伤86例患者,按照治疗方式的不同分为观察组(n=45)与对照组(n=41),两组同时接受常规治疗,观察组在其基础上予以早期(4h内)连续性床旁血滤治疗,测定两组治疗前及治疗后第1、3天血肌酐(Scr)、血尿素氮(BUN)、氧合指数、超敏C-反应蛋白、降钙素原及内毒素水平,同时观察两组出院并随访28d病死率。结果:两组治疗3d后的血肌酐、尿素氮、超敏C反应蛋白、降钙素原水平均下降,且观察组较对照组下降明显,差异有统计学意义(P<0.05);观察组氧合指数较对照组升高明显,差异有统计学意义(P<0.05);观察组病死率(20.0%)较对照组(41.5%)明显低,差异有统计学意义(P<0.05);两组内毒素水平比较,差异无统计学意义(P>0.05)。结论:早期连续性床旁血滤治疗可减轻脓毒性休克合并急性肾损伤患者炎症反应,有效改善治疗效果,能明显降低病死率。但在降低内毒素方面未表现出明显差异。
Objective:To investigate the efficacy of early continuous bedside hemofiltration in patients with septic shock and acute kidney injury and its effect on serum endotoxin level.Method:A retrospective study was conducted on 86 cases of patients with septic shock combined with acute kidney injury admitted to the department of Critical Care,Affiliated Hospital of Weifang Medical University from July 2013 to December 2018.The patients were divided into the observation group(n=45) and the control group(n=41) according to different treatment methods.Both groups received conventional treatment at the same time.The observation group based on its to early(4 hours) continuous bedside hemofiltration treatment,and the levels of serum creatinine(Scr),blood urea nitrogen(BUN),oxygenation index,hypersensitive C-reactive protein(hs-CRP),procalcitonin(PCT) and endotoxin were measured before treatment and 1, 3 days after treatment,and changes in mortality at discharge or 28 days in both groups were observed.Result:After 3 days of treatment,the levels of serum creatinine,urea nitrogen,hypersensitive c-reactive protein and PCT in both groups were decreased,and the observation group were significantly lower than the control group,with statistically significant differences(P<0.05).The oxygenation index in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).The mortality of the observation group(20.0%) was significantly lower than that of the control group(41.5%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in endotoxin levels between the two groups(P>0.05).Conclusion:Early bedside continuous renal replacement therapy can reduce the inflammatory response in patients with septic shock and acute kidney injury,effectively improve the treatment effect,and significantly reduce the mortality.However,there is no significant difference in reducing endotoxin.
作者
周涛
韩荣荣
陈宇峰
ZHOU Tao;HAN Rongrong;CHEN Yufeng(Affiliated Hospital of Weifang Medical University,Weifang 261000,China)
出处
《中外医学研究》
2019年第23期16-18,共3页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
连续性床旁血滤
脓毒性休克
急性肾损伤
内毒素
Continuous renal replacement therapy
Septic shock
Acute kidney injury
Endotoxin
