不同时机CRRT治疗对脓毒症患者炎症指标血流动力学及预后的影响

doi:10.3969/j.issn.1006-6233.2019.11.039

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Abstract Objective: To study the effects of different timing of continuous renal replacement therapy (CRRT) on inflammation markers, hemodynamics and prognosis in patients with sepsis. Methods: The clinical data of 54 patients with sepsis admitted to the hospital from January 2016 to December 2018 were retrospectively analyzed. The patients were divided into simple sepsis group (n=27) and septic shock group (n=27) according to the condition of patients with CRRT therapy. The infection status, acute physiology and chronic health evaluation II (APACHE II), inflammation markers, hemodynamics and prognosis were observed in the two groups before and after treatment. Results: The levels of white blood cells (WBC), procalcitonin (PCT) and body temperature in septic shock group before treatment were significantly higher than those in sepsis group (P<0.05). After treatment, the levels of WBC, PCT and body temperature in the two groups were significantly lower than those in the same group before treatment (P<0.05), and the levels of WBC and PCT in septic shock group after treatment were significantly higher than those in sepsis group (P<0.05). Before treatment and after 3d and 7d treatment, the APACHE II scores in the two groups showed a downward trend (P<0.05), and the APACHE II scores in septic shock group were significantly higher than those in sepsis group before treatment and after 3d and 7d of treatment (P<0.05). Before treatment, the levels of tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) in septic shock group were significantly higher than those in sepsis group (P<0.05), and there was no significant difference in the level of IL-6 between the two groups before treatment (P>0.05). After treatment, the levels of serum TNF-α, CRP and IL-6 in the two groups were significantly lower than those in the same group before treatment (P<0.05), and the levels of TNF-α, CRP and IL-6 in septic shock group after treatment were significantly higher than those in sepsis group (P<0.05). There were no significant differences in the heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) between the two groups before treatment (P>0.05). After treatment, the HR level in sepsis group was significantly lower than that in the same group before treatment (P<0.05), and there were no significant changes in the levels of MAP and CVP (P>0.05), and the HR level in septic shock group after treatment was significantly lower than that in the same group before treatment, and the MAP level was significantly higher than that in the same group before treatment (P<0.05), and there was no significant change in CVP level (P>0.05), and the HR level in septic shock group after treatment was significantly higher than that in sepsis group while the MAP level was significantly lower than that in sepsis group (P<0.05), and there was no significant difference in CVP level between the two groups (P>0.05). The 28d mortality rate in sepsis group after CRRT therapy was significantly lower than that in septic shock group (P<0.05). Conclusion: CRRT can effectively eliminate the inflammatory mediators and maintain hemodynamic stability in patients with sepsis and septic shock. Early CRRT intervention can effectively improve the prognosis and prolong the survival time of patients with sepsis.

Key words： Sepsis patients Different timing Continuous renal replacement therapy Inflammation markers Hemodynamics

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2019.11.039 OR http://www.hbyxzzs.cn/EN/Y2019/V25/I11/1906