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CRRT治疗脓毒症休克并发急性肾损伤的临床效果
作者：韩佳滨 岳桂芳 郑露 弭晓丹 王立新 来源：《中国现代医生》2020年第19期
[摘要] 目的 探討脓毒症休克并发急性肾损伤应用连续性血液净化治疗的临床效果及对患者SCr水平的影响。 方法 选取2018年4月～2019年12月我院收治的68例脓毒性休克并发急
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性肾损伤患者，按照随机数表顺序将其分入到对照组和观察组，每组34例。对照组采用现行常规治疗方案治疗，观察组在常规治疗方案基础上增加连续性血液净化治疗。对比两组患者患者治疗期间血清炎症因子、SCr、BUN以及患者的预后情况。 结果 两组患者治疗前IL-6、TNF-α、CRP水平对比无统计学意义（P>0.05）;治疗后，两组患者的IL-6、TNF-α、CRP水平均显著低于治疗前（P0.05）;治疗后，两组患者的SCr、BUN指标水平均显著低于治疗前（P [关键词] 脓毒性休克;急性肾损伤;连续性血液净化;炎症因子;血肌酐
[中图分类号] R692;R459.7; ; ; ; ; [文献标识码] B; ; ; ; ; [文章编号] 1673-9701（2020）19-0107-03
Clinical effect of CRRT in treatment of septic shock complicated with acute kidney injury HAN Jiabin1; ;YUE Guifang2; ;ZHENG Lu3; ;MI Xiaodan1; ;WANG Lixin1
1.Department of Critical Care Medicine， Affiliated Hospital of Binzhou Medical University， Binzhou; 256600， China; 2.Department of Anesthesiology， Affiliated Hospital of Binzhou Medical University， Binzhou 256600， China; 3.Department of Anesthesiology， Qingdao Chinese Medicine Hospital， Qingdao 266000， China
[Abstract] Objective To explore the clinical effect of continuous blood purification treatment on acute sepsis shock complicated with acute kidney injury and the effect on SCr level of patients.
Methods Sixty-eight cases of septic shock complicated with acute kidney injury in our hospital from April 2018 to December 2019 were selected. They were divided into control group and observation group according to the order of random number table， with 34 cases in each group. The control group was treated with the current conventional treatment plan， and the observation group was also given continuous blood purification treatment based on the conventional treatment plan. The serum inflammatory factors， SCr， BUN and prognosis of patients during treatment were compared between the two groups. Results There were no statistically significant differences in the levels of IL-6， TNF-α and CRP between the two groups before treatment（P>0.05）. The levels of IL-6， TNF-α and CRP in the two groups after treatment were significantly lower than those before treatment（P<0.05）. And the above indexes of patients in the observation group were lower than those in the control group， which was statistically significant（P<0.05）. Before treatment， the SCr and BUN index levels of the two groups were not statistically significant（P>0.05）. The SCr and BUN index levels of the two groups after treatment were significantly lower than those before treatment
（P<0.05）. And the level of the above indicators in the observation group was lower than that of the control group（P<0.05）. The 28-day survival rate of the observation group was higher than that of the control group， and the hospital stay of the observation group was shorter than that of the control group（P<0.05）. Conclusion Continuous blood purification treatment for patients with septic shock and acute kidney injury has an important role in improving the patient's serum inflammation level，
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and can also reduce the patient's SCr and BUN levels. It is of great significance for improving the prognosis of patients and is worthy of application.
[Key words] Septic shock; Acute kidney injury; Continuous blood purification; Inflammatory factors; Blood creatinine
脓毒性休克是临床极为严重的危急重症，患者由于各种因素导致机体出现全身炎症反应，继而造成全身器官的功能障碍甚至衰竭[1]。部分患者还合并急性肾损伤，大量患者因急性肾损伤而病故，对于脓毒性休克并发急性肾损伤患者的治疗临床多采用对症、支持治疗，即予以患者营养支持、抗休克、抗感染等。得益于现代医学的发展，连续性血液净化技术不断成熟，在治疗脓毒性休克并发急性肾损伤中发挥了重要作用，使得患者的死亡率有一定程度的下降[2]。本次研究以我院收治的部分患者作为研究对象，探讨增加连续性血液净化治疗对改善患者机体炎症水平、血肌酐等的意义，现报道如下。 1 资料与方法 1.1 一般资料
本次研究选择2018年4月～2019年12月我院收治的68例脓毒性休克并发急性肾损伤患者，按照随机数表顺序将其分入到对照组和观察组，每组34例。纳入标准：①符合《脓毒性休克治疗指南（2014）》[3]中关于脓毒性休克并发急性肾损伤的诊断;②患者或家属知情本次研究，签署知情同意书;③资料保存完整者。排除标准：①合并其他重大疾病者;②精神或认知功能存在障碍，不能配合研究者;③中途退出、放弃治疗者。观察组中，男21例，女13例;年龄43～72岁，平均（56.29±7.30）岁;病程1～12年;平均（5.89±2.10）年。对照组中，男20例，女14例;年龄38～74岁，平均（55.59±7.56）岁;病程1～14年;平均（6.12±2.15）年。本次研究经伦理委员会批准，两组患者一般资料比较，差异无统计学意义（P>0.05），具有可比性。 1.2 方法
对照组采用现行的常规治疗干预，主要包括生命体征监测、抗休克、抗感染、早期液体复苏、呼吸支持、营养支持、血管活性药物等。观察组在对照组基础上应用连续性血液净化治疗，选择颈静脉或股静脉作双腔导管留置位;仪器为百特Aquarius持续血液净化系统治疗及其配套的HF1200型滤器，按照操作规范建立临床血管通路，相关参数控制为：血流量180～250 mL/min，置换液流量2000～3000 mL/h，行连续性血液净化治疗，血液净化期间注意记录患者的相关生化指标。并予以患者低分子肝素抗凝，如患者有严重的出血倾向，则使用无肝素抗凝，生理盐水冲管。两组患者治疗7 d后观察疗效。 1.3 观察指标
CRRT治疗脓毒症休克并发急性肾损伤的临床效果
