摘要
目的研究剂量连续性肾脏替代疗法(CRRT)对严重脓毒症患者免疫功能、肠黏膜屏障功能及预后转归的影响。方法对92例行CRRT治疗的严重脓毒症患者的临床及随访资料进行回顾性分析。根据治疗剂量不同分为A组(20 ml/kg)29例,B组(40 ml/kg)32例,C组(60 ml/kg)31例。比较3组患者治疗前后的炎性指标[白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)]、免疫功能(CD+4、CD+8、CD+4/CD+8)、肠黏膜屏障功能指标[细菌内毒素(BT)、血浆二胺氧化酶(DAO)、血浆D-乳酸(D-Lac)]及预后指标[急性生理学及慢性健康状况评分(APACHEⅡ)、序贯器官衰竭估计评分(SOFA评分)]水平变化情况。结果3组患者治疗后IL-6、TNF-α、CRP水平均较治疗前下降(P<0.05),且B、C组各炎性指标水平下降程度高于A组,C组各炎性指标水平下降程度高于B组(P<0.05);3组患者治疗后CD+4、CD+4/CD+8水平均较治疗前上升,CD+8水平均较治疗前下降(P<0.05),与A组比较B、C组CD+4、CD+4/CD+8水平上升明显,CD+8水平下降明显(P<0.05),与B组比较C组CD+4、CD+4/CD+8水平上升明显,CD+8水平下降明显(P<0.05);3组患者治疗后BT、DAO、D-Lac水平均较治疗前下降(P<0.05),与A组比较B、C组BT、DAO、D-Lac水平下降明显(P<0.05),与B组比较C组CBT、DAO、D-Lac水平下降明显(P<0.05);3组患者治疗后APACHEⅡ、SOFA评分均较治疗前下降(P<0.05),与A组比较B、C组APACHEⅡ、SOFA评分水平下降明显(P<0.05),与B组比较C组APACHEⅡ、SOFA评分水平下降明显(P<0.05)。结论不同剂量CRRT可有效的改善严重脓毒症患者免疫功能,提高肠黏膜屏障功能保护能力,降低炎性因子水平,促进预后转归。
Objective To investigate the effects of high dose CRRT on immune function,intestinal mucosal barrier function and prognosis of patients with severe sepsis.Methods A total of 92 patients with severe sepsis who were treated by CRRT in our hospital from May 2016 to March 2019 were enrolled in the study.The clinical and follow-up data of patients were analyzed retrospectively.According to the different doses of treatment,these patients were divided into group A(20ml/kg,n=29),group B(40ml/kg,n=32)and group C(60ml/kg,n=31).The changes of inflammatory indexes(IL-6,TNF-α,CRP),immune function(CD+4,CD+8,CD+4/CD+8),intestinal mucosal barrier function indexes(BT,DAO,D-Lac)before and after treatment as well as prognosis indexes(APACHEⅡ,D-Lac)and SOFA scores were observed and compared among the three groups.Results After treatment the levels of IL-6,TNF-αand CRP in the three groups were significantly decreased,as compared with those before treatment(P<0.05),moreover the decrease degree in group B and C was more significant than that in group A(P<0.05).After treatment,the levels of CD+4 and CD+4/CD+8 in the three groups were significantly increased,but the levels of CD+8 significantly decreased(P<0.05),moreover,the increase degree and decrease degree in group B and group C were more significant than those in group A(P<0.05).In addition the levels of BT,DAO and D-Lac in the three groups were significantly decreased after treatment(P<0.05),and the decrease degree in group B and group C was more significant than that in group A(P<0.05),moreover,which in group C was more significant than that in group B(P<0.05).After treatment the scores of APACHEⅡand SOFA in the three groups were significantly decreased(P<0.05),and decrease degree in group B and group C was more significant than that in group A(P<0.05),moreover,which in group C was more significant than that in group B(P<0.05).Conclusion The high-dose CRRT can effectively improve the immune function of patients with severe sepsis,improve the protective ability of intestinal mucosal barrier function,reduce the levels of inflammatory factors,and improve the prognosis of patients.
作者
白准
刘旭丽
曾维忠
彭苏娜
吴双华
BAI Zhun;LIU Xuli;ZENG Weizhong(Department of Critical Care Medicine,Zhuzhou Central Hospital,Hunan,Zhuzhou 412000,China)
出处
《河北医药》
CAS
2020年第12期1856-1859,共4页
Hebei Medical Journal
关键词
大剂量治疗剂量
连续性肾脏替代疗法
严重脓毒症
免疫功能
肠黏膜屏障功能
预后转归
high dose
continuous renal replacement therapy
severe sepsis
immune function
intestinal mucosal barrier function
prognosis and outcome
