|本期目录/Table of Contents|

[1]郭剑,雷洁洁,章柏平,等.脓毒症患者连续性肾替代治疗时机选择及预后比较[J].医学研究与战创伤救治(原医学研究生学报),2018,20(01):37-40.[doi:10.3969/j.issn.1672-271X.2018.01.008]
　GUO Jian,LEI Jie-jie,ZHANG Bo-ping,et al.Comparison of timing and prognosis of continuous renal replacement therapy in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(01):37-40.[doi:10.3969/j.issn.1672-271X.2018.01.008]
点击复制

脓毒症患者连续性肾替代治疗时机选择及预后比较()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第20卷
期数:
2018年01期
页码:
37-40
栏目:
出版日期:
2018-01-22

文章信息/Info

Title:
Comparison of timing and prognosis of continuous renal replacement therapy in patients with sepsis
作者:
郭剑; 雷洁洁; 章柏平; 吴辉
作者单位：335000鹰潭，解放军第184医院急诊与重症医学科（郭剑、雷洁洁、章柏平、吴辉）
Author(s):
GUO Jian;  LEI Jie-jie;  ZHANG Bo-ping;  WU Hui
(Department of Emergency and Critical Care Medicine, the 184th Hospital of PLA, Yingtan 335000,Jiangxi,China)
关键词:
脓毒症; 血液滤过; 连续性肾替代疗法; 治疗时机
Keywords:
sepsis;  hemofiltration;  continuous renal replacement therapy;  timing of treatment
分类号:
R459.7
DOI:
10.3969/j.issn.1672-271X.2018.01.008
文献标志码:
A
摘要:
目的 对比脓毒症患者连续性肾替代治疗时机选择及预后情况。方法 回顾性分析解放军第184医院行血液滤过治疗的脓毒症210例患者，其中112例治疗前急性生理学与慢性健康状况评分II（APACHEⅡ）评分< 25分者为低APACHEⅡ评分组，98例APACHEⅡ评分≥ 25分者为高APACHEⅡ评分组，对比2组治疗前后各生化及生理指标的情况。结果 治疗后2组心率、动脉血氧分压、白细胞、尿素氮、血肌酐及血小板计数等均优于治疗前（P<005），且低APACHEⅡ评分组心率、血小板计数、尿素氮、血肌酐等均优于高APACHEⅡ评分组（P<005）。休克、血液滤过开始时间、APACHEⅡ评分是影响患者预后的独立危险因素（P<005）。结论 连续性肾替代治疗可有效改善脓毒症患者各生化及生理指标，有助于改善其病情转归情况。休克、血液滤过开始时间、APACHEⅡ评分是影响脓毒症患者预后的独立危险因素，早期对APACHEⅡ评分较低的患者进行血液滤过治疗能够明显改善其疗效，改善患者预后情况。
Abstract:
Objective To compare the timing and prognosis of continuous renal replacement therapy in patients with sepsis.Methods Retrospectively analysis of 210 patients with sepsis receiving hemofiltration treatment was conducted in our hospital. 112 cases whose acute physiology and chronic health evaluation II score (APACHE II)＜25 points before treatment was regarded as the low APACHE II score group, and those of APACHE II scores ≥25 points as the high APACHE II score group. The biochemical and physiological indexes before and after treatment were compared between the two groups.Results After treatment, the levels of heart rate, arterial partial pressure of oxygen, white blood cells, blood urea nitrogen, serum creatinine, blood platelet, and others of the two groups were better than those before treatment (P＜0.05).The heart rate, blood platelet, blood urea nitrogen, serum creatinine of the low APACHE II score group were better than those in the high APACHE II score group (P＜0.05). Shock, starting time of hemofiltration and APACHE II score were independent risk factors on prognosis (P＜0.05).Conclusion Continuous renal replacement therapy can effectively improve the biochemical and physiological indexes of patients with sepsis, which can help to improve their prognosis. Shock, starting time of hemofiltration and APACHE II score are independent risk factors on prognosis in patients with sepsis. Early hemofiltration treatment on patients with lower APACHE II scores can significantly improve their curative effects and prognosis.

参考文献/References:

[1]Villa G, Neri M, Bellomo R, et al. Nomenclature for renal replacement therapy and blood purification techniques in critically ill patients: practical applications[J]. Crit Care, 2016,20(1):283.[2]黄伟. 《第三版脓毒症与感染性休克定义国际共识》解读[J]. 中国实用内科杂志,2016,36(11):959-962.[3]Villa G, Di MP, De Gaudio AR, et al. Effects of continuous renal replacement therapy on linezolid pharmacokinetic/pharmacodynamics: a systematic review[J]. Crit Care, 2016,20(1):374.[4]刘翔, 龚德华, 季大玺, 等. 连续性肾脏替代治疗患者体外循环凝血的危险因素及护理研究进展[J].中华护理杂志,2013,48(4):377-379.[5]Boucher BA, Hudson JQ, Hill DM, et al. Pharmacokinetics of Imipenem/Cilastatin Burn Intensive Care Unit Patients Undergoing High-Dose Continuous Venovenous Hemofiltration[J]. Pharmacotherapy, 2016,36(12):1229-1237.[6]黄凤楼, 刁孟元, 钱海飞, 等. 降钙素原及内毒素对腹腔感染脓毒症患者预后的评估[J].东南国防医药,2014,16(2):147-149, 191.[7]Dai X, Li T, Zeng Z, et al.The effect of continuous venovenous hemofiltration on neutrophil gelatinase-associated lipocalin plasma levels in patients with septic acute kidney injury[J]. BMC Nephrol, 2016,17(1):154.[8]Roger C, Wallis SC, Louart B, et al. Comparison of equal doses of continuous venovenous haemofiltration and haemodiafiltration on ciprofloxacin population pharmacokinetics in critically ill patients[J]. J Antimicrob Chemother, 2016,71(6):1643-1650.[9]马雅琳, 陈思, 史媛媛, 等. 连续性肾脏替代治疗非计划性下机的影响因素及防范策略[J].中国老年学杂志,2017,37(3):770-773.[10]陈伟, 陈右江, 丁祥飞, 等. 连续性肾脏替代治疗在腹腔脓毒症合并急性呼吸窘迫综合征中的应用[J].中国急救医学,2013,33(5):404-407.[11]Tokumasu H, Watabe S, Tokumasu S. Effect of hemodiafiltration therapy in a low-birthweight infant with congenital sepsis[J]. Pediatr Int, 2016,58(3):237-240.[12]Jamal JA, Roberts DM, Udy AA, et al. Pharmacokinetics of piperacillin in critically ill patients receiving continuous venovenous haemofiltration: A randomised controlled trial of continuous infusion versus intermittent bolus administration[J]. Int J Antimicrob Agents, 2015,46(1):39-44.[13]Shiga H, Hirasawa H, Nishida O, et al. Continuous hemodiafiltration with a cytokine-adsorbing hemofilter in patients with septic shock: a preliminary report[J]. Blood Purif, 2014,38(3-4):211-218.[14]季大玺,吴丛业.肾脏替代治疗在急性肾损伤应用中的争议和共识[J].医学研究生学报,2015,28(9):897-903.[15]Sun J, Shi S, Wang Q, et al. Continuous hemodiafiltration therapy reduces damage of multi-organs by ameliorating of HMGB1/TLR4/NFκB in a dog sepsis model[J].Int J Clin Exp Pathol,2015,8(2):1555-1564.

相似文献/References:

[1]张 丽,侯毅翰,张民伟,等.降钙素原在血流感染中的临床应用分析[J].医学研究与战创伤救治(原医学研究生学报),2013,15(06):603.[doi:10.3969/j.issn.1672-271X.2013.06.016]
　ZHANG Li,HOU Yi-han,ZHANG Min-wei,et al.Cost-effective analysis of procalcitonin in the diagnosis of bloodstream infection[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2013,15(01):603.[doi:10.3969/j.issn.1672-271X.2013.06.016]
[2]黄凤楼,刁孟元,钱海飞,等.降钙素原及内毒素对腹腔感染脓毒症患者预后的评估[J].医学研究与战创伤救治(原医学研究生学报),2014,16(02):147.[doi:10.3969/j.issn.1672-271X.2014.02.011]
　HUANG Feng-lou,DIAO Meng-yuan,QIAN Hai-fei,et al.Prognostic value of procalcitonin and endotoxin concentrations for intra-abdominal sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(01):147.[doi:10.3969/j.issn.1672-271X.2014.02.011]
[3]刘 瑜,方 放,黄 方.糖皮质激素受体基因多态性与脓毒症临床转归的相关性研究[J].医学研究与战创伤救治(原医学研究生学报),2015,17(06):575.[doi:10.3969/j.issn.1672-271X.2015.06.005]
　LIU Yu,FANG Fang,HUANG Fang..Association of polymorphisms in glucocorticoid receptor with outcome of sepsis in a Chinese Han population[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(01):575.[doi:10.3969/j.issn.1672-271X.2015.06.005]
[4]窦燕,郭以河,孔晓飞,等.创伤弧菌脓毒症1例报道并文献复习[J].医学研究与战创伤救治(原医学研究生学报),2018,20(01):76.[doi:10.3969/j.issn.1672-271X.2018.01.018]
[5]李勇,宋薇.连续性血液净化联合益气活血法对脓毒症伴心肌功能障碍患者的临床疗效观察[J].医学研究与战创伤救治(原医学研究生学报),2018,20(03):225.[doi:10.3969/j.issn.1672-271X.2018.03.001]
　LI Yong,SONG Wei.The clinical efficacy of continuous blood purification combined with Yiqi Huoxue for the sepsis patients with myocardial dysfunction[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(01):225.[doi:10.3969/j.issn.1672-271X.2018.03.001]
[6]林青伟,宋景春,曾庆波,等.大黄素对脓毒症大鼠凝血紊乱治疗的作用[J].医学研究与战创伤救治(原医学研究生学报),2018,20(05):464.[doi:10.3969/j.issn.1672-271X.2018.05.004]
　LIN Qing-wei,SONG Jing-chun,ZENG Qing-bo,et al.Effect ofemodin on coagulation disorders of septic rats[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(01):464.[doi:10.3969/j.issn.1672-271X.2018.05.004]
[7]谢醒文,杨振宁,葛鑫,等.脓毒症相关凝血功能障碍对脓毒症患者预后的评估价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(2):161.[doi:10.3969/j.issn.1672-271X.2020.02.011]
　XIE Xing wen,YANG Zhen ning,GE Xin,et al.A clinical research on relationship between sepsisassociated coagulopathy and prognosis in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(01):161.[doi:10.3969/j.issn.1672-271X.2020.02.011]
[8]钟林翠,宋景春,姜峻,等.血小板聚集率在评价脓毒症患者血小板功能及预后中的价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(3):249.[doi:10.3969/j.issn.1672-271X.2020.03.006]
　ZHONG Lin-cui,SONG Jing-chun,JIANG Jun,et al.Clinical study on platelet aggregation to evaluate platelet function and prognosis in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(01):249.[doi:10.3969/j.issn.1672-271X.2020.03.006]
[9]曾庆波,宋景春,钟林翠,等.严重创伤与脓毒症患者凝血功能紊乱的比较研究[J].医学研究与战创伤救治(原医学研究生学报),2020,22(4):367.[doi:10.3969/j.issn.1672-271X.2020.04.007]
　ZENG Qing-bo,SONG Jing-chun,ZHONG Lin-cui,et al.Comparation of coagulation dysfunction between severe trauma and sepsis patients[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(01):367.[doi:10.3969/j.issn.1672-271X.2020.04.007]
[10]陈慧敏,王立群,黄利民,等.降钙素原变化率对创伤后脓毒症患者抗生素合理使用的指导价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(4):408.[doi:10.3969/j.issn.1672-271X.2020.04.016]

备注/Memo

备注/Memo:
-
更新日期/Last Update: 2018-01-20