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

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。

Abstract:

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.