参芪地黄汤治疗脓毒症并发急性肾损伤疗效观察及对尿蛋白的影响

目的:分析参芪地黄汤治疗脓毒症并发急性肾损伤(AKI)的疗效及对患者尿蛋白的影响。方法:将2014年1月至2016年12月收治的脓毒症并发AKI患者经筛选后纳入研究,共76例,根据入院奇偶数进行分组。对照组采用常规对症治疗,观察组在此基础上加用参芪地黄汤,对比两组治疗前后肾损伤情况和炎症指标的变化。结果:①治疗第1天,两组患者肾功能指标血尿素氮(BUN)、血肌酐(SCr)和胱抑素C(Cys C)均持续恶化,但观察组恶化程度小于对照组(均P0.05),第3天和第7天以上指标均好转,但均高于治疗前,且观察组低于对照组,组间比较差异均有统计学意义(P0.05)。②治疗第1天,两组患者尿β2-微球蛋白(β2-MG)、24 h尿蛋白定量和尿量指标均持续恶化,但观察组恶化程度小于对照组,第3天和第7天以上指标均好转,且均高于治疗前,观察组优于对照组。③治疗第1天、第3天和第7天,两组患者炎症指标降钙素原(PCT)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)均持续下降,均低于治疗前(P0.05),且观察组均低于对照组(P0.05)。④治疗第1天,急性生理学及慢性健康状况评分系统(APACHE-II)得分和序贯器官衰竭估计评分(SOFA)得分均上升,第3天和第7天以上指标均持续下降,且观察组均低于对照组(P0.05)。⑤对照组28 d死亡率和肾脏替代治疗患者比例均高于观察组,但差异无统计学意义(P 0.05)。结论:参芪地黄汤对脓毒症并发AKI具有保护作用,能降低患者炎症水平及尿蛋白量。

Observation of Effect of Shenqi Dihuang Decoction on Treatment of Sepsis Complicated with Acute Kidney Injury and Urine Protein

Objective:To analyze the efficacy of Shenqi Dihuang Decoction on treatment of sepsis compli cated with acute kidney injury(AKI) and its effect on urine protein in patients. Methods:A total of 76 sepsis patients with AKI treated from January 2014 to December 2016 were selected and divided into two groups according to the odevity of their admission number. The control group was given conventional symptomatic treatment and the observation group was combined with Shenqi Dihuang Decoction. Renal injury index and inflammation index of the two groups before and after treatment were observed.Results:On the 1 st day,the kidney function indicators such as blood urea nitrogen(BUN),serum creatinine(Scr) and cystatin C(Cys C) level of the two groups continued to deteriorate,and the deterioration degree of the observation group was lower than that of the control group(P<0.05). On the 3 rd and the 7 th day,the above indicators were improved in the two groups,but were higher than those before treatment,and the indicator levels in the observation group were lower than those in the control group(P<0.05). ②On the 1 st day,urinary β2-microglobulin(β2-MG),24 h urine protein quantity and urine volume of the two groups continued to deteriorate,and the deterioration degree of the observation group was lower than that of the control group. On the 3 rd and the 7 th day,the above indicators were improved in the two groups,which were higher than those before treatment,and the indicator levels in the observation group were better than those in the control group. ③On the 1 st,the 3 rd and the 7 th day,The levels of inflammation indicators such as procalcitonin(PCT),tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) in the two groups continued to decline,so they were lower than those before treatment. The levels of the above indicators in the observation group were lower than those in the control group(P<0.05). ④On the 1 st day,APACHE-II score and SOFA score of the two groups increased.On the 3 rd and the 7 th day,the indicators continued to decline and those in the observation group were lower than those in the control group(P<0.05). ⑤The 28 day mortality rate and renal replacement therapy rate of the control group were higher than those of the observation group,but the differences were not statistically significant(P> 0.05). Conclusion:Shenqi Dihuang Decoction has protective effect on sepsis patients with AKI and it can reduce the level of inflammation and urine protein.