连续肾脏替代治疗联合血液灌流对MODS合并急性肾损伤患者炎性反应的影响

目的探讨连续肾脏替代治疗(CRRT)联合血液灌流(HP)治疗对多器官功能障碍综合征(MODS)合并急性肾损伤(AKI)患者炎性反应的影响。方法 MODS患者40例随机分为CRRT组及联合组各20例。CRRT组采用连续性静脉—静脉血液滤过方式治疗72 h,联合组在CRRT治疗基础上每24 h进行2 h HP治疗,检测患者一般情况(HR、MBP)、心/肾功能指标(BUN、SCr、CO_2CP)、血清肿瘤坏死因子-α(TNF-α)、白介素-1(IL-1)、白介素-6(IL-6)、白介素-8(IL-8)的变化。结果与治疗前比较,2组治疗后HR降低,MBP升高,且联合组改善优于CRRT组(P<0.05),2组BUN、SCr下降,CO_2CP升高(P<0.05),而2组间差异无统计学意义(P>0.05)。与治疗前比较2组治疗48、72 h后,血清中TNF-α、IL-1、IL-6、IL-8水平均下降(P<0.05)。联合组治疗72 h后较CRRT组下降明显(P<0.05)。结论对于MODS合并AKI患者,CRRT联合HP较单用CRRT对改善心、肾功能及清除炎性因子具有更好的疗效。

The impact of CRRT hemoperfusion MODS inflammatory response in patients with AKI

Objective To evaluate the effects of continuous renal replacement therapy （CRRT） combined with he-moperfusion （HP） on inflammation in multiple organ dysfunction syndrome （MODS） complicated with acute kidney injury （AKI） patients.Methods 40 MODS patients were randomly divided into combine group and CRRT group with 20 cases in each group.CRRT group with continuous veno -venous hemofiltration way of treating 72 h,combine group on the basis of CRRT treatment, carried out 2 h HP treatment every 24 h, detected patients generally condition （HR, MBP）, renal function （BUN, SCr, CO2 CP）, tumor necrosis factor-α（TNF-α）, interleukin-1 （IL-1）, interleukin-6 （IL-6）, changes in interleu-kin-8 （IL-8）.Results Compared with before treatment, the two groups after treatment reduces HR , and MBP was increased, and combine group better than CRRT group （ P ＆lt;0.05）, 2 groups＆#39;BUN, SCr were decreased, CO2 CP was increased （ P ＆lt;0.05）, whereas no statistically significant difference between the two groups was found （ P ＆gt;0.05）.After treatment 48, 72 h, serum TNF-α, IL-1, IL-6, IL-8 levels were decreased in both 2 groups （ P ＆lt;0.05） compared with before treatment.Af-ter 72 h treatment, compared with CRRT group, these indexes in combine group were decreased more significantly （ P ＆lt;0.05）.Conclusion CRRT combined with hemoperfusion has better therapeutic effect of anti-inflammation in MODS compli-cated with AKI patients than CRRT treatment alone .