早期CRRT干预对腹源性脓毒症患者免疫调节作用的研究

doi:10.3969/j.issn.1004-7115.2021.02.007

betway必威登陆网址（betway.com ）学报 ›› 2021, Vol. 42 ›› Issue (2): 102-104.DOI: 10.3969/j.issn.1004-7115.2021.02.007

早期CRRT干预对腹源性脓毒症患者免疫调节作用的研究

毛克江, 雷学智

佛山市第一人民医院重症医学科,广东佛山 528000

收稿日期:2020-10-20 发布日期:2021-09-01
作者简介:毛克江(1970—),男,河南原阳人,副主任医师,硕士,主要从事临床重症神经及感染工作。E-mail:mkj701113@163.com。
基金资助:
佛山市自筹经费类科技计划项目(编号:2017AB001411)。

Effect of early CRRT intervention on immunoregulation in patients with abdominal sepsis

MAO Ke-jiang, LEI Xue-zhi

Dept. of Critical Care Medicine, First Peoples Hospital, Foshan City 528000,China

Received:2020-10-20 Published:2021-09-01

摘要/Abstract

摘要： 目的观察早期进行连续肾脏替代疗法(continuous renal replacement therapy,CRRT)干预对腹源性脓毒症患者免疫功能的影响。方法取我院ICU 2018年1月至2020年6月的AS患者60例,随机分两组,常规治疗按指南进行;治疗组AKI1级时进行CRRT干预,治疗最少3天,每天至少12小时。对照组则AKI2级或以上时CRRT,方案相同。记录干预前及干预后第7天的感染指标、免疫指标等。统计分析应用SPSS 24.0软件进行t检验。结果治疗组PCT、HLA-DR、CD4⁺/CD8⁺等均显著改善(P<0.01)。结论早期CRRT的干预能及时阻断免疫麻痹,减轻炎症反应,改善预后。

关键词: 腹源性脓毒症(AS), 持续肾脏替代治疗(CRRT), 早期干预, 免疫调节

Abstract: Objective:To observe the effect of early CRRT intervention on immune function in patients with abdominal sepsis.Methods:Sixty patients with abdominal sepsis in ICU of our hospital for two and a half years were randomly divided into two groups. The routine treatment was carried out according to the guidelines while the treatment group was given CRRT intervention at AKI level 1, at least 3 days,at least 12 hours a day.In the control group, CRRT was used when AKI was 2 or above.The infection index and immune index were recorded before and 7 days after the intervention.SPSS 24.0 software was used for t test.Results:PCT, HLA-DR,CD4⁺/CD8⁺ were significantly improved in the treatment group (P<0.01).Conclusion:Early CRRT intervention can block immune paralysis, reduce inflammatory reaction and improve prognosis

Key words: abdominal sepsis , continuous renal replacement therapy (CRRT), early intervention, immune regulation

中图分类号:

R459.7

毛克江, 雷学智. 早期CRRT干预对腹源性脓毒症患者免疫调节作用的研究[J]. betway必威登陆网址（betway.com ）学报, 2021, 42(2): 102-104.

MAO Ke-jiang, LEI Xue-zhi. Effect of early CRRT intervention on immunoregulation in patients with abdominal sepsis[J]. Journal of Shandong First Medical Unversity & Shandong Academy of Medical Sciences, 2021, 42(2): 102-104.

参考文献

[1] Honore PM, Jacobs R, Joannes-Boyau O, et al. Newly designed CRRT membranes for sepsis and SIRS-a pragmatic approach for bedside intensivists summarizing the more recent advances: a systematic structured review[J]. ASAIO J, 2013,59(2):99-106.
[2] Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012[J]. Intensive Care Med, 2013,39(2):165-228.
[3] Luan YY,Dong N,Xie M,et al.Thesignificanace and regulatory mechanisms of innate immune cells in the development of sepsis [J].Interferon Cytonkine Res,2014,34(1):2-15.
[4] 黄鹤,田昭涛,黎檀实.脓毒症免疫调节机制研究进展[J].中华实验外科杂志,2016,33(3):841-845.
[5] LaszloI,Trasy D,Molnar Z,et al.Sepsis:From Pathophysiology to Individualized Patient Care[J].J Immunol Res,2015,2015:510436.
[6] Lekkou A,Kamkantza M,Mouzaki A,et a1.Cytokine production and monocyte HLR-DR expression as predictors of outcome for patients with conmmunity acquired severe infections[J].Clin Diagn Lab Immunol,2004, 11:161-167.
[7] 苏磊,周殿元,唐柚青,等.CDl4+单核细胞人自细胞DR抗原在脓毒症早期监测中的临床意义[J].中国危重病急救医学,2006,ll(18):677-679.
[8] 周立新,李轶男,誉铁鸥,等.重度脓毒症患者单核细胞HLA-DR水平与预后的关系[J].广东医学, 2009,30(5):730-732.
[9] Honore PM, Jacobs R, Joannes-Boyau O, et al. Con: Dialy- and continuous renal replacement (CRRT) trauma during renal replacement therapy: still under-recognized but on the way to better diagnostic understanding and prevention[J]. Nephrol Dial Transplant, 2013,28(11):2723-2727.
[10] Bauer SR, Salem C, Connor MJ Jr, et al. Pharmacokinetics and pharmacodynamics of piperacillin-tazobactam in 42 patients treated with concomitant CRRT[J]. Clin J Am SocNephrol, 2012,7(3):452-7.
[11] Bagshaw SM,Uchino S, BellomoR,et al.Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury[J].J Crit care,2009,24(1):129-140.
[12] Ronco C,BellomoR.Acute renal failure and multiple organ dysfunction in the ICU:from renal replacement therapy (RRT) to multiple organ support therapy (MOST)[J].Int J Artif Organ,2002,25(8):733-747.
[13] Kellum J A,LameireN.Diagnosis, evaluation, and management of acute kidney injury:a KDIGO summary (Part 1)[J].Crit Care, 2013,17(1):204.
[14] Tian H,Sun T,Hao D,et al.The optimal timing of continuous renal replacement therapy for patients with sepsis-induced acute kidney injury [J].IntUrolNephrol,2014,46(10):2009-2014.
[15] Baek SD, Yu H, Shin S,et al. Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion. Journal of critical care,2017,39:108-114.
[16] Perez-Fernandez X, Sabater-Riera J, Sileanu FE,et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy. Journal of critical care,2017,40:154-60.
[17] Lee JH, Kim HY, Bae EH, et al. Biomarkers Predicting Survival of Sepsis Patients Treated with Continuous Renal Replacement Therapy. Chonnam medical journal. 2017,53(1):64-8.
[18] 王海波,徐丽娟,李克鹏,等.KDIGO标准APACHE II与SOFA评分对脓毒症急性肾损伤患者的预后评估[J].中国急救医学,2013,33(6):499-502.
[19] Doi K. Role of kidney injury in sepsis. Journal of intensive care. 2016,4:17.
[20] 唐小宇.脓毒血症急性肾损伤患者行连续性肾脏替代治疗的时机和疗效[J].内科急危重症杂志, 2016,(22):137-139.

早期CRRT干预对腹源性脓毒症患者免疫调节作用的研究

Effect of early CRRT intervention on immunoregulation in patients with abdominal sepsis

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 0

编辑推荐

Metrics