重症肝炎CRRT中置换液剂量同CRRT清除能力及效果的相关性

【摘要】 目的通过观察连续性肾脏替代治疗(CRRT)联合血浆置换(PE)对终末期重症肝炎合并肾衰竭患者炎症及肾功能指标的影响,以进一步探讨置换液剂量与肾功能指标的相关性。方法以2011年6月~2013年6月河南省人民医院内科收治的24例终末期重症肝炎合并肾衰竭的患者为研究对象。按照随机数字表格法将24例研究对象分为对照组与观察组(n=12)。对照组采用内科常规治疗和PE治疗。观察组在对照组的的基础上加用CRRT。观察2组患者治疗前后炎症指标[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、高敏C反应蛋白(hs-CRP)]及肾功能指标[血尿素氮(BUN)及血清肌酐(SCr)]的改善情况。结果与治疗前相比,治疗后观察组和对照组患者的炎症指标hs-CRP、IL-6及TNF-α,肾功能指标BUN、SCr均明显下降(r=11.136、9.261、10.919、8.056、3.669,P<0.05),且观察组的炎症指标及肾功能指标比同期对照组显著降低,差异均有统计学意义(r=19.432、12.950、20.597、19.757、15.738,P<0.05)。12例观察组中35mL/(kg·h)组、65mL/(kg·h)组、100mL/(kg·h)组各4例;肾功能指标BUN、SCr水平与置换液剂量均不存在相关性(r=0.3246、0.3158,P>0.05)。结论 CCRT联合PE可降低终末期重症肝炎合并肾衰竭患者的hs-CRP、IL-6、TNF-α、BUN及SCr水平,改善预后,置且换液剂量对CCRT没有明显的影响。更多还原

【Abstract】 Objective To observe the effect of continuous renal replacement therapy(continuous renal replacement therapy, CRRT) combined with plasma exchange(plasma replacement, PE) on end-stage hepatitis associated with inflammatory of renal failure and renal function indicators in patients, to further explore the relationship between change of liquid dosage and renal function indices. Methods 24 cases of end-stage severe hepatitis with renal failure in patients from June 2011 to June 2013 in department of internal medicine in our hospital treated as the research object. According to the random number table method, 24 patients were divided into two groups, control group and observation group with 12 cases in each.The control group received conventional treatment in the department of internal medicine and PE treatment. The observation group were treated with CRRT basing on the the control group. Two groups were observed the improve ment situation of inflammatory markers [interleukin 6(IL-6), tumor necrosis factor alpha(TNF- α),high sensitivity C reactive protein(hs-CRP) and renal function indices [blood urea nitrogen(blood urea nitrogen, BUN) and serum creatinine(serum creatinine, SCr) before and after treatment in patients. Results Compared with before treatment, after treatment, inflammatory markers such as hs-CRP, IL-6 and TNF- α, renal function indexes BUN, SCr in the observation group and the control of patients decreased significantly(r=11.136、9.261、10.919、8.056、3.669,P<0.05), inflammatory index and the index of renal function in the observation group decreased significantly than the control group in the same period, the differences were statistically significant(r=19.432、12.950、20.597、19.757、15.738,P<0.05). 12 cases in observation group of 35 mL/(kg?h) group, 65 mL/(kg?h) group, 100 mL/(kg?h) group with 4 patients in each group; renal function indexes of BUN, SCr and fluid replacement doses were not correlated(r=0.3246, 0.3158, P>0.05). Conclusion CCRT combined with PE can be reduced the hs-CRP, IL-6, TNF- α, BUN and SCr levels in patients with end-stage renal failure and severe hepatitis, improve the prognosis, and change the liquid dose had no influence on CCRT.更多还原