血清ET-1水平对连续性肾脏替代治疗非计划下机和疗效的指示性作用分析

目的考察血清内皮素-1(ET-1)水平对连续性肾脏替代治疗非计划下机和疗效的指示性作用。方法 180例重症监护室患者入院后均接受对连续性肾脏替代治疗(CRRT),测定患者治疗前和治疗后4 d血清ET-1水平并选取30例健康对照。分析血清ET-1水平与APACHEⅡ及非计划下机的相关性。结果 180例患者中非计划下机29例,非计划下机率16.1%。77例治疗前后病菌学检查均为阴性(Ⅰ组),79例前后病菌学检查均为阳性(Ⅱ组),24例治疗前阴性但治疗72 h后出现病原学阳性(Ⅲ组)。所有患者中血清ET-1水平显著高于健康对照(P<0.05)。且Ⅱ组和Ⅲ组患者显著高于I组患者(P<0.05)。动态观察显示,Ⅰ组患者治疗后血清ET-1水平显著下降(P<0.05),但其他两组无显著变化(P>0.05)。非计划下机患者血清ET-1水平显著高于其他患者(P<0.05)。治疗前和治疗后4 d血清ET-1与APACHEⅡ评分均显著正相关(r=0.61,r=0.77,P<0.05)。结论血清ET-1是CRRT患者病情严重程度的有效指示,治疗后的ET-1对患者预后评价效果更优。

Indicative Effect of Serum ET-1 Level on Unplanned Disembarkation and Outcomes of Continuous Renal Replacement Therapy

Objective To investigate the indicative effect of serum endothelin-1 (ET-1) level on unplanned disembarkation and outcomes of continuous renal replacement therapy. Methods 180 patients in intensive care unit received continuous renal replacement therapy (CRRT) after admission. Serum ET-1 levels were measured before and 4 days after treatment, and 30 healthy controls were selected. To analyze the correlation between serum ET-1 level and APACHEⅡ and unplanned disembarkation. Results Among 180 patients, 29 (16.1%) were unplanned disembarkation. 77 cases were negative before and after treatment ( groupⅠ), 79 cases were positive before and after treatment (groupⅡ), 24 cases were negative before treatment but positive after 72 hours of treatment (groupⅢ). The level of serum ET-1 in all patients was significantly higher than that in healthy controls ( P <0.05 ). And groupⅡ and groupⅢ were significantly higher than groupⅠ( P <0.05). Dynamic observation showed that the level of serum ET-1 in group I decreased significantly after treatment ( P <0.05), but there was no significant change in other two groups ( P >0.05 ). The level of serum ET-1 in unplanned patients was significantly higher than that in other patients ( P <0.05). Serum ET-1 was positively correlated with APACHEⅡ scores before and 4 days after treatment ( r =051, r =0.72, P <0.05). Conclusion Serum ET-1 is an effective indicator of the severity of CRRT, and ET-1 is more effective in evaluating CRRT patients after treatment.