早期连续性肾脏替代治疗严重脓毒症合并急性左心衰患者的疗效

目的探究早期连续性肾脏替代(Early continuous renal replacement,CRRT)治疗严重脓毒症合并急性左心衰患者的临床疗效及对机体心肌肌钙蛋白(Cardiac troponin I,cTnI)、N端前脑钠肽(N terminal pro brain natriuretic peptide,NT-proBNP)、中性粒细胞/淋巴细胞比值(Neutrophil to lymphocyte ratio,NLR)水平的影响。方法选取胜利油田中心医院2016年1月-2017年12月收治的严重脓毒症合并急性左心衰竭患者79例,按随机数字法分为对照组39例和治疗组40例,对照组患者采用常规治疗,治疗组患者在常规治疗的基础上采用CRRT治疗,比较治疗前后两组患者的急性生理学与慢性健康状况评价系统Ⅱ(Acute physiology and chronic health assessment system II,APACHEⅡ)评分、序贯器官衰竭估计(Sequential organ failure assessment,SOFA)评分、氧合指数及左室射血分数(Left ventricular ejection fraction,LVEF),判断CRRT治疗的疗效,比较治疗前后两组患者的CRP、cTnI、NT-proBNP及NLR水平,分析治疗前后两组患者免疫功能指标(CD4^+、CD8^+、CD4^+/CD8^+、IgA、IgG和IgM)情况。结果治疗前,两组患者APACHEⅡ评分及SOFA评分比较差异无统计学意义;治疗后,两组患者APACHEⅡ评分及SOFA评分均降低,且治疗组各指标水平优于对照组,差异均有统计学意义(P<0.05);治疗后,两组患者氧合指数、LVEF、CD4^+、CD4^+/CD8^+、IgA、IgG和IgM均上升,CD8^+水平下降,且治疗组各指标水平优于对照组,差异均有统计学意义(P<0.05)。结论CRRT治疗可有效改善严重脓毒症合并急性左心衰患者的机体免疫情况,减轻炎症反应,对于患者的预后情况有改善作用。

Effect of early continuous renal replacement therapy for patients with severe sepsis and acute left heart failure

OBJECTIVE To investigate the clinical efficacy of early continuous renal replacement therapy in patients with severe sepsis and acute left heart failure and its effects on cTnI,NT-proBNP and NLR levels.METHODS Total of 79 patients with severe sepsis and acute left heart failure admitted to Shengli Oilfield Central Hospital from January 2016 to December 2017 were enrolled.According to the random number method,they were divided into the control group and the treatment group.Thirty-nine patients in the control group were treated with conventional therapy.Forty patients in the treatment group were treated with CRRT on the basis of conventional treatment.The acute physiology and chronic health assessment system II(APACHE II)scores and sequential organs failure assessment(SOFA),oxygenation index and left ventricular ejection fraction(LVEF)were compared between the two groups before and after the treatment to evaluate the curative effect of CRRT.Levels of CRP,cTnI,NT-proBNP,NLR and indexes of CD4^+,CD8^+,CD4^+/CD8^+,IgA,IgG and IgM were also compared between both groups before and after the treatment.RESULTS Before the treatment,there was no significant difference in APACHE II score and SOFA score between the two groups.After the treatment,the APACHE II score and SOFA score in the two groups were significantly decreased(P<0.05).After the treatment,the oxygenation index,LVEF,CD4^+,CD4^+/CD8^+,IgA,IgG and IgM in the two groups increased significantly,and the level of CD8^+decreased significantly(P<0.05).CONCLUSION Early continuous renal replacement therapy can effectively improve the immunoreaction in patients with severe sepsis and acute left heart failure.It can reduce the inflammatory response,significantly improve the prognosis of patients,which is worthy of clinical use.