杂合式肾脏替代治疗高龄全身炎症反应综合征伴急性肾损伤患者的效果观察

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摘要目的探讨杂合式肾脏替代治疗高龄全身炎症反应综合征伴急性肾损伤患者的临床效果。方法选取我院2012年5月～2014年5月由重症肺炎、心脏疾病及脑血管意外引起的38例全身炎症反应综合征并急性肾损伤高龄患者，根据治疗方法的不同分为HRRT组（20例）与对照组（18例）。HRRT组给予常规治疗联合连续性静脉-静脉血液透析滤过+血浆置换（CVVHDF+PE），对照组给予常规治疗。比较两组的APACHEⅡ评分、肾功能、炎症因子、血气分析、免疫功能指标（CD4+、CD8+、CD4+/CD8+）及半年生存率。结果HRRT组治疗后的CD8+、IL-10、IL-6、TNF-α水平低于治疗前及对照组治疗后，CD4+、CD4+/CD8+水平高于治疗前及对照组治疗后，差异有统计学意义（P＜0.05）。HRRT组治疗后的pH、HCO3-水平高于治疗前及对照组治疗后，PCO2、血Cr、血BUN水平以及APACHEⅡ评分低于治疗前及对照组治疗后，差异有统计学意义（P＜0.05）。HRRT组的半年生存率为85.0%，明显高于对照组的44.4%，差异有统计学意义（P＜0.05）。结论对于重症肺炎、心脏疾病及脑血管意外引起的全身炎症反应综合征并急性肾损伤，在常规治疗基础上，尽早应用杂合式肾脏替代治疗能有效清除体内多种毒素及炎症介质，纠正酸碱平衡紊乱，改善免疫抑制状态及临床症状，最终提高高龄患者的救治成功率。

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	崔梦笔
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	查艳

关键词 ：杂合式肾脏替代治疗, 急性肾损伤, 全身炎症反应综合征

Abstract：ObjectiveTo investigate the clinical efficacy of hybrid renal replacement therapy in the treatment of elderly patients with systemic inflammatory response syndrome accompanied with acute kidney injury.MethodsFrom May 2012 to May 2014,38 cases of systemic inflammatory response syndrome accompanied with severe acute kidney injury in elderly patients with severe pneumonia,heart disease and cerebrovascular accident were selected and divided into the HRRT group(20 cases)and the control group(18 cases)according to the different treatment methods.The HRRT group was given routine treatment combined with continuous veno venous hemofiltration plus plasma exchange(CVVHDF+PE),the control group was given routine treatment.The APACHEⅡscore,renal function,blood gas analysis,inflammatory factors and immune function index(CD4+,CD8+,CD4+/CD8+)and the half year survival rate in the two groups were compared.ResultsThe levels of CD8+,IL-10,IL-6 and TNF-α in the HRRT group after treatment was lower than that before treatment and in the control group after treatment,and the levels of CD4+,CD4+/CD8+in the HRRT group after treatment was higher than that before treatment and the control group after treatment,with significant difference(P＜0.05).The levels of pH and HCO3-in the HRRT group after treatment was higher than that before treatment and in the control group after treatment,the level of PCO2,serum Cr,serum BUN and APACHEⅡ score in the HRRTgroup after treatment was lower than that before treatment and in the control group after treatment,with significant difference(P＜0.05).The half year survival rate of the HRRT group was 85.0%,which was higher than 44.4%of the control group,with significant difference(P＜0.05).ConclusionFor systemic inflammatory response syndrome complicated with acute kidney injury due to severe pneumonia,heart disease and cerebrovascular accident syndrome,on the basis of routine treatment,early application of HRRT can effectively remove various toxins and inflammatory mediators,correct the imbalance of acid-base balance,improve the immunosuppressive status and clinical symptoms,and ultimately improve the success rate of treatment of elderly patients.

Key words： Hybrid renal replacement therapy Acute kidney injury Systemic inflammatory response syndrome

基金资助:贵州省优秀青年科技人才培养对象专项资金项目[黔科合人字（2013）43号]

作者简介: 崔梦笔（1989-），女，研究方向：腹膜透析；王松（1979-），男，副主任医师，研究方向：中西医结合肾病治疗*对本文与第一作者有同等贡献

引用本文:

崔梦笔；王松；胡杉杉；苏凤籼；查艳. 杂合式肾脏替代治疗高龄全身炎症反应综合征伴急性肾损伤患者的效果观察[J]. 中国当代医药, 2017, 24(19): 53-56.
CUI Meng-bi；WANG Song；HU Shan-shan；SU Feng-xian；ZHA Yan. Effect observation of hybrid renal replacement therapy in the treatment ofelderly patientswith systemicinflammatory responsesyndrome accompanied with acute kidney injury. 中国当代医药, 2017, 24(19): 53-56.

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