连续性肾脏替代疗法对重症急性胰腺炎相关性肾损害的疗效及炎性介质的影响

目的分析连续性肾脏替代疗法(CRRT)对重症急性胰腺炎(SAP)相关性肾损害(KI)的疗效及炎性介质的影响。方法选取2009年7月至2011年7月河南大学第一附属医院收治的SAP相关性KI患者81例,按照随机数字表法分为两组:对照组39例进行常规治疗,观察组43例进行CRRT治疗,对比两组患者的治疗效果及炎性介质的变化情况。结果观察组气管插管患者比例显著少于对照组,治疗后APACHEⅡ评分显著低于对照组(P<0.05),两组病死率及病死患者存活时间比较差异无统计学意义(P>0.05);两组患者治疗后24 h尿量均上升,观察组上升程度较对照组更为显著(P<0.05),观察组尿素氮、血清肌酐显著下降,尿素氮及血清肌酐显著上升(P<0.05);两组患者治疗后C反应蛋白、脂联素均上升,观察组上升程度较对照组更为显著(P<0.05),观察组肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)显著下降,对照组TNF-α、IL-6显著上升(P<0.05)。结论CRRT能够有效改善SAP相关性KI患者的临床症状,降低其死亡风险,且能够促进其肾功能的恢复,降低机体炎性介质水平,从而得到良好的治疗效果,值得临床推广应用。

Curative Effect of Continuous Renal Replacement Therapy for Kidney Injury Associated with Severe Acute Pancreatitis and Its Impact on Inflammatory Mediators

Objective To analyze the curative effect of continuous renal replacement therapy （CRRT） for renal impairment （KI） associated with severe acute panereatitis （SAP） and its impact on inflammatory mediators. Methods A total of 81 patients with KI associated with SAP admitted in First Affiliated Hospital of Henan University from Jul. 2009 to Jul. 2011 were randomly divided into two groups： patients in control group （ n = 39） were given conventional treatment, while patients in observation group （ n = 43 ） were treated with CRRT,the curative effects and changes of the inflammatory mediators of the two groups were compared. Results Ratio of patients with tracheal intubation of the observation group was significantly lower than that of the control group, and acute physiology and chronic health evaluation （APACHE） ]1 score of the observation group after treatment was significantly lower than that of the control group （ P 〈 0.05 ）, there were no statistically significant differences of mortality and survival time of fatality patients between the two groups（ P 〉 0.05 ） ; urine volumes of the two groups all increased 24 h after treatment, while those of the observation group increased more significantly than those of the control group （ P 〈 0.05 ） ,levels of urea nitrogen, serum creatinine of the observation group significantly decreased, urine specific gravity of the control group decreased, and levels of blood urea nitrogen and serum creatinine of the control group increased （ P 〈 0.05 ） ; levels of reactive protein, adiponectin of the two groups all increased after treatment,while those of the observation group increased more significantly than the control group （ P 〈 0.05 ）, levles of tumor necrosis factor α,interleukin-6 of the observation group decreased significantly, while those of the control group increased significantly （ P 〈 0.05）. Condusion CRRT can effectively improve the clinical symptoms of patients with KI associated with SAP,reduce the risk of d