局部枸橼酸抗凝对脓毒症急性肾损伤血液滤过患者免疫功能的影响

发布时间：2018-03-10 16:18

本文选题：局部枸橼酸抗凝(RCA)　切入点：脓毒症急性肾损伤(SAKI)　出处：《生物医学工程与临床》2017年03期 　论文类型：期刊论文

【摘要】：目的对比研究局部枸橼酸抗凝(RCA)与全身肝素抗凝对脓毒症急性肾损伤(SAKI)行连续性静脉-静脉血液滤过(CVVH)患者免疫功能的影响。方法选择南京医科大学附属无锡市人民医院2012年2月至2016年4月确诊的70例SAKI患者进行前瞻性研究,其中男性40例,女性30例;年龄36~82岁,平均年龄56.32岁。原发病:重症肺炎42例,急性重症胰腺炎12例,急性胆管炎10例,急性弥漫性腹膜炎6例。患者随机分为全身肝素抗凝组(A组,34例)和RCA组(B组,36例),两组患者均行CVVH 48 h。分别观察两组患者CVVH治疗0、12、24、48 h白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,并监测两组CVVH治疗0 h和48 h CD3~+百分比、CD4~+百分比、CD4~+/CD8~+比值的变化。比较两组滤器使用寿命、28 d病死率。结果两组患者CVVH治疗12 h和24 h,A组IL-6值、TNF-α值均高于B组,差异均有统计学意义(P0.05)。CVVH治疗48 h A组CD3+百分比、CD4~+百分比、CD4~+/CD8~+比值显著低于B组,差异均有统计学意义(P0.05)。此外,A组滤器使用寿命(25.86±7.32)h,显著低于B组[(39.80±4.68)h],A组28 d病死率(48.72%)显著高于B组(29.56%),差异均有统计学意义(P0.05)。结论与全身肝素抗凝比较,SAKI患者CVVH时使用RCA,能更有效清除炎性因子及调节患者T淋巴细胞亚群免疫稳态,改善患者预后。
[Abstract]:Objective to compare the effects of local anticoagulant citrate (RCA) and systemic heparin anticoagulation on immune function of patients with septic acute renal injury (SAKI) undergoing continuous veno-venous hemofiltration (CVVH). Methods Wuxi City affiliated to Nanjing Medical University was selected. A prospective study was conducted in 70 patients with SAKI diagnosed in the people's Hospital from February 2012 to April 2016. There were 40 males and 30 females, aged 36 to 82 years, with an average age of 56.32. The primary diseases were severe pneumonia (42 cases), severe acute pancreatitis (12 cases), acute cholangitis (10 cases). 6 cases of acute diffuse peritonitis were randomly divided into two groups: systemic heparin anticoagulant group (group A, n = 34) and RCA group (n = 36, group B, n = 36). The patients in both groups were treated with CVVH for 48 h. The levels of interleukin-6 sil 6 and tumor necrosis factor- 伪 TNF- 伪 were observed in two groups of patients treated with CVVH for 24 48 h. The changes of CD4 ~% CD4 ~% CD4- / CD8- / CD4- / CD8- / CD4- / CD8- / CD4- / CD8- / CD4- / CD8- / CD4-% ratio in two groups were monitored after 0 h and 48 h of CVVH treatment. The mortality of the two groups was compared. Results the IL-6 value of group A was higher than that of group B at 12 h and 24 h after CVVH treatment. All the differences were statistically significant. The percentage of CD3 in group A was significantly lower than that in group B after 48 h treatment. In addition, the service life of filter in group A was 25.86 卤7.32 hs, which was significantly lower than that in group B [39.80 卤4.68 h] and the fatality rate in group A was significantly higher than that in group B in 28 days. The difference was significant (P0.055.Conclusion compared with systemic heparin anticoagulant, SAKI patients were treated with CVVH. RCA can effectively remove inflammatory factors and regulate the immune homeostasis of T lymphocyte subsets in patients. To improve the prognosis of patients.
【作者单位】：南京医科大学附属无锡市人民医院重症医学科;
【分类号】：R459.7;R692

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