血清Cys C指导下肾替代治疗脓毒症合并多器官功能障碍综合征的疗效研究

doi:10.3969/j.issn.1006-6233.2018.06.011

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Abstract Objective: To investigate the reference value of serum cystatin C (Cys C) detection on the continuous renal replacement therapy time of the patients with sepsis combined multiple organ dysfunction syndrome (MODS). Methods: 86 cases of sepsis combined with MODS were selected from June 2015 to August 2017 in our hospital with ICU. According to the time intervals between the time point of serum Cys C level began to increase and the time point of continuous renal replacement therapy began, they were divided into group A (<48h, 34 cases), group B (48~72h, 25 cases) and group C (>72h, 27 cases). The changes of 24h vital signs before and after continuous renal replacement therapy were recorded and compared, including heart rate, body temperature, APACHE II score and SOFA score; 48h cardiac index (CI), stroke output index (SVI), mean arterial pressure (MAP) and peripheral vascular resistance index (SVRI) levels were monitored before treatment and after treatment; venous blood and arterial blood samples were taken before treatment and 48h after treatment, the contents of alanine aminotransferase (ALT), total bilirubin (TBIL), blood urea nitrogen (BUN), serum creatinine (Scr), blood lactate and procalcitonin (PCT) were measured. Results: ①Compared with before treatment, the 24h heart rate, body temperature, APACHE II score and SOFA score of the three groups were significantly lower (P<0.05) after continuous renal replacement therapy. Compared with group B and C, the heart rate, body temperature, APACHE II score and SOFA score in group A were significantly decreased (P<0.05). ②Compared with before treatment, the 48h CI, SVI and MAP increased significantly (P<0.05) and SVRI significantly decreased (P<0.05) in the three groups after continuous renal replacement therapy. Compared with group B and C, the increase of CI, SVI and MAP was more significant (P<0.05), and the decrease of SVRI was more significant (P<0.05) in group A. ③Compared with before treatment, ALT, TBIL, BUN, Scr, blood lactic acid and PCT decreased significantly in the three groups at 48h after continuous renal replacement therapy (P<0.05). Compared with group B and C, the decrease of ALT, TBIL, BUN, Scr, blood lactic acid and PCT in group A was more significant (P<0.05). ④The time of continuous renal replacement therapy and the time of ICU hospitalization in group A were significantly less than those in group B (P<0.05); the time of continuous renal replacement therapy and the time of ICU hospitalization in group B were significantly less than those in group C (P<0.05). The 4 weeks mortality rate in group A was lower than that in group B and group C, but the difference was not statistically significant (P>0.05). Conclusion: Continuous renal replacement therapy within 48h of serum Cys C level may better control the condition of septic patients with MODS.

Key words： Sepsis Multiple organ dysfunction syndrome Continuous renal replacement therapy Cystatin C

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2018.06.011 OR http://www.hbyxzzs.cn/EN/Y2018/V24/I6/923

[1] 李小丽,刘鲁沂,初静,等.配对血浆吸附滤过治疗重症脓毒症并发多器官功能障碍综合征的研究[J].中华急诊医学杂志,2017,26(8):919~923.
[2] 易梦秋,余旻.脓毒症导致多器官功能障碍的发病机制[J].实用医学杂志,2016,32(20):3451~3454.
[3] 王敏,刘虹,程威.脓毒症急性肾损伤早期生物标志物的新进展[J].中国临床研究,2016,29(3):424~426.
[4] 黄莉莉,缪华杰,陆洋,等.脓毒症患者血清胱抑素C、尿液肾脏损伤分子1水平变化及其对并发急性肾损伤的诊断价值[J].山东医药,2017,57(31):70~72.
[5] 吕雪.早期连续性肾脏替代治疗对严重脓毒症患者的影响[J].实用心脑肺血管病杂志,2016,24(s1):46~49.
[6] Dellinger R P, Levy M M, Carlet J M, et al. Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock: 2008[J]. Intensive Care Medicine, 2008, 34(1):17~60.
[7] Marshall J C. Multiple organ dysfunction syndrome (MODS)[M].Clinical trials for the treatment of sepsis. Berlin Heidelberg: Springer, 1995:122~138.
[8] 喻文,罗红敏.脓毒症相关多器官功能障碍综合征的表征[J].中华危重病急救医学,2015,27(6):524~524.
[9] 刘阳,樊蕴辉,刘晨,等.参附注射液联合低剂量氢化可的松对脓毒症多脏器功能障碍综合征患者血浆PCT和HLA-DR水平的影响[J].天津医药,2016,44(4):501~504.
[10] 陈玉红,郑明,李斌,等.不同连续性肾脏替代治疗模式及其剂量对脓毒症合并急性肾损伤患者溶质清除效果的研究[J].中国全科医学,2016,19(18):2145~2150.
[11] 畅毅平,张玉强,张永利.连续性肾脏替代治疗脓毒症临床研究进展[J].临床肺科杂志,2017,22(2):344~346.
[12] Leem A Y, Park M S, Park B H, et al. Value of serum cystatin C measurement in the diagnosis of sepsis-induced kidney injury and prediction of renal function recovery[J]. Yonsei Medical Journal, 2017, 58(3):604~612.
[13] 尹良琼,余艾霞.降钙素原、胱抑素C联合检测对脓毒症患儿28天死亡率的预测价值研究[J].现代检验医学杂志,2017,32(2):153~156.