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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
陈绵军,陈军,谭德敏,王凯,蒙振发,王御林,苏显都.连续性肾脏替代治疗对老年脓毒症患者的疗效分析[J].中华老年多器官疾病杂志,2018,17(3):211~215
连续性肾脏替代治疗对老年脓毒症患者的疗效分析
Continuous renal replacement therapy for elderly patients with sepsis:156 cases analysis
投稿时间:2017-10-06  修订日期:2017-11-21
DOI:10.11915/j.issn.1671-5403.2018.03.046
中文关键词:  老年人;脓毒症;连续性肾脏替代治疗;免疫功能;炎性因子
英文关键词:aged; sepsis; continuous renal replacement therapy; immune function; inflammatory factors
基金项目:
作者单位E-mail
陈绵军 海南省儋州市人民医院 重症医学科,儋州 571799 chenmianjun_1981@163.com 
陈军 海南省儋州市人民医院 重症医学科,儋州 571799;海南省儋州市人民医院 急诊科,儋州 571799  
谭德敏 海南省儋州市人民医院 重症医学科,儋州 571799  
王凯 海南省儋州市人民医院 重症医学科,儋州 571799  
蒙振发 海南省儋州市人民医院 重症医学科,儋州 571799  
王御林 海南省儋州市人民医院 重症医学科,儋州 571799  
苏显都 海南省儋州市人民医院临床检验科,儋州 571799  
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中文摘要:
      目的 探讨连续性肾脏替代治疗(CRRT)对老年脓毒症患者的疗效。方法 采用前瞻性研究方法选取2014年1月至2017年6月海南省儋州市人民医院重症医学科收治的156例老年脓毒症患者为研究对象,按照随机数字表法随机分为CRRT组和对照组,每组各78例。对照组采用常规治疗,CRRT组在常规治疗的基础上采用CRRT。观察2组患者治疗前及治疗3、7 d 后外周血免疫指标、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)及高敏C-反应蛋白(hs-CRP)水平及急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)、多器官功能障碍综合征(MODS)评分及序贯性器官衰竭评估评分(SOFA)。治疗28 d后,对2组疗效进行比较。采用SPSS 19.0软件对数据进行统计分析。根据数据类型,组间比较采用t检验、重复测量的方差分析或χ2检验。结果 2组患者治疗7 d后CD3+、CD4+及CD14+水平均显著高于治疗前和治疗3 d后,且CRRT组治疗7 d后CD3+[(69.3±8.7)% vs (63.8±8.4)%]、CD4+[(36.8±13.3)% vs (31.5±10.6)%]及CD14+[(55.7±6.8)% vs (46.8±6.5)%]水平均显著高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗7 d后IL-6、TNF-α、PCT及hs-CRP水平均显著低于治疗前和治疗3 d后,差异有统计学意义(P<0.05);CRRT组治疗3 d后IL-6、TNF-α、PCT及hs-CRP水平显著低于治疗前,差异有统计学意义(P<0.05);治疗3、7 d后CRRT组上述指标均显著低于对照组,差异均有统计学意义[ IL-6:(40.7±3.8) vs (68.4±5.2) ng/L, (18.5±2.6) vs (37.8±3.5) ng/L; TNF-α:(28.4±10.7) vs (36.5±14.2) μg/L, (20.3±7.8) vs (27.9±11.4) μg/L; PCT:(4.3±1.7) vs (6.2±2.3) μg/L, (1.3±0.8) vs (3.6±1.4) μg/L, hs-CRP:(52.6±15.4) vs (71.3±18.4) mg/L, (22.5±9.3) vs (36.4±12.7) mg/L; P<0.05]。2组患者治疗7 d后APACHEⅡ、MODS及SOFA评分均明显低于治疗前,差异有统计学意义(P<0.05);CRRT组治疗7 d后APACHEⅡ、MODS及SOFA评分亦显著低于治疗3 d后,差异有统计学意义(P<0.05)。治疗7 d后CRRT组APACHE Ⅱ[(10.8±4.2) vs (14.3±4.8)分]、MODS[(4.5±1.9) vs (6.1±2.3)分]及SOFA评分[(3.6±1.4) vs (5.8±1.7)分]显著低于对照组,差异均有统计学意义(P<0.05)。治疗28 d后,CRRT组治愈率明显高于对照组,差异有统计学意义(70.5% vs 48.7%,P=0.006)。结论 CRRT辅助常规治疗对老年脓毒症患者的临床疗效有所改善,可提高患者的免疫功能及降低炎症反应。
英文摘要:
      Objective To investigate the efficacy of continuous renal replacement therapy (CRRT) in elderly patients with sepsis. Methods A prospective study was carried out on 156 elderly sepsis patients admitted in our hospital from January 2014 to June 2017. They were randomly divided into CRRT group and control group, with 78 cases in each group. The control group was treated with conventional therapy, and CRRT group was treated with CRRT on the basis of conventional treatment. Peripheral blood immune indices, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and high sensitivity C-reactive protein (hs-CRP) before treatment and 3 and 7 days after treatment were measured and recorded. The curative effects after 28 days’ treatment and scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), multiple organ dysfunction syndrome (MODS) and sequential organ failure assessment (SOFA) were analyzed and compared between the 2 groups. SPSS statistics 19.0 was used to analyze the data. For different data types, Student’[KG-*3]s t test, repeated measures analysis of variances or Chi-square test was employed for the com-parison between two groups. Results In the 2 groups, the peripheral blood proportions of CD3+, CD4+ and CD14+ in the 7th day aftertreatment were significantly higher than those before treatment and in the 3rd day, and the proportions of CD3+ [(69.3±8.7)% vs (63.8±8.4)%], CD4+ [(36.8±13.3)% vs (31.5±10.6)%] and CD14+[(55.7±6.8)% vs (46.8±6.5)%] in the 7th day were obviously higher in the CRRT group than the control group (P<0.05). The serum levels of IL-6, TNF-α, PCT and hs-CRP were remarkably decreased in both groups in 7 days after treatment when compared with the levels before treatment and after 3 days’ treatment (P<0.05). Their levels in the CRRT group were notably lower than those in the control group in 3 and 7 days’ after treatment [IL-6:(40.7±3.8) vs (68.4±5.2) ng/L, (18.5±2.6) vs (37.8±3.5) ng/L; TNF-α:(28.4±10.7) vs (36.5±14.2) μg/L, (20.3±7.8) vs (27.9±11.4) μg/L; PCT:(4.3±1.7) vs (6.2±2.3) μg/L, (1.3±0.8) vs (3.6±1.4) μg/L, hs-CRP:(52.6±15.4) vs (71.3±18.4) mg/L, (22.5±9.3) vs (36.4±12.7) mg/L, all P<0.05]. The scores of APACHE Ⅱ, MODS and SOFA at the 7th day were significantly lower in the 2 groups than those before treatment (P<0.05). The CRRT group had obviously lower APACHE Ⅱ score [(10.8±4.2) vs (14.3±4.8)], MODS score [(4.5±1.9) vs (6.1±2.3)] and SOFA score [(3.6±1.4) vs (5.8±1.7)] in the 7th day when compared with the control group (P<0.05). After 28 days’ treatment, the curative rate was remarkably higher in the CRRT group than in the control group (70.5% vs 48.7%, P=0.006). Conclusion CRRT, in combination with conventional treatment, improves the clinical efficacy, promotes the immune function and reduces the inflammatory responses in elderly patients with sepsis.
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