连续性血液净化治疗危重症患儿急性肾损伤的临床疗效及其机制研究

发布时间：2018-02-08 13:25

本文关键词： 急性肾损伤儿童血液透析滤过　出处：《中国全科医学》2017年36期 　论文类型：期刊论文

【摘要】：目的探究连续性血液净化(CBP)治疗危重症患儿急性肾损伤(AKI)的临床疗效及其机制,以期为临床治疗提供借鉴。方法回顾性选取2009年9月—2014年12月安徽省儿童医院肾内科合并AKI的危重症患儿44例为研究对象。根据治疗方法将其分为内科治疗组(17例,采用内科综合治疗)和CBP治疗组(27例,在给予内科综合治疗后仍不能缓解的患儿,取得家长同意后行CBP治疗)。收集患儿一般资料,记录两组治疗前及治疗24 h、48 h、1周的临床指标和炎性因子;比较两组临床疗效。结果治疗方法与时间在血钾、CO_2结合力、血肌酐上存在交互作用(P0.05),在血钠、尿素氮、胱抑素C上不存在交互作用(P0.05);治疗方法在血钾上主效应显著(P0.05),在血钠、CO_2结合力、尿素氮、血肌酐、胱抑素C上主效应不显著(P0.05);时间在血钠、CO_2结合力、尿素氮、血肌酐、胱抑素C上主效应显著(P0.05),在血钾上主效应不显著(P0.05)。CBP治疗组治疗48 h尿素氮、血肌酐、胱抑素C低于治疗前(P0.05);CBP治疗组治疗1周血钾、尿素氮、血肌酐、胱抑素C低于治疗前(P0.05);内科治疗组治疗1周血钠高于治疗前,尿素氮、血肌酐低于治疗前(P0.05)。治疗方法与时间在肿瘤坏死因子α(TNF-α)、白介素(IL)-6、IL-10上存在交互作用(P0.05);治疗方法在TNF-α、IL-6、IL-10上主效应显著(P0.05);时间在TNF-α、IL-6、IL-10上主效应显著(P0.05)。CBP治疗组治疗24 h TNF-α、IL-6低于治疗前(P0.05);CBP治疗组治疗48 h、1周TNF-α、IL-6、IL-10低于治疗前(P0.05);CBP治疗组总有效率(96.3%,26/27)高于内科治疗组(70.6%,12/17)(P0.05)。结论 CBP治疗危重症患儿AKI的临床疗效优于内科综合治疗,其能有效调节细胞炎性因子,纠正患儿紊乱的免疫功能。
[Abstract]:Objective to investigate the clinical efficacy and mechanism of continuous blood purification (CBP) in the treatment of acute renal injury (AKI) in critically ill children. Methods from September 2009 to December 2014, 44 critically ill children with AKI in Department of Nephrology, Children's Hospital of Anhui Province were selected as the study objects. According to the treatment methods, they were divided into the internal medicine treatment group (n = 17) and the control group (n = 17). 27 patients in the CBP treatment group were treated with CBP after receiving comprehensive medical treatment. The general data of the patients were collected, and the general data of the patients were collected, and the general data of the patients were collected, and the general data of the patients were collected, and the general data of the patients were collected. The clinical indexes and inflammatory factors of the two groups were recorded before treatment and 24 h after treatment for 48 h, and the clinical efficacy was compared between the two groups. Results the therapeutic methods and time were combined with serum potassium and CO _ 2, and there was interaction between serum creatinine (P 0.05), blood sodium and urea nitrogen. There was no interaction on cystatin C (P 0.05). The main effect of treatment was significant in blood potassium, but not in blood sodium, urea nitrogen, serum creatinine and cystatin C. time was found in blood sodium CO2, urea nitrogen, serum creatinine, blood creatinine, blood creatinine, blood creatinine, blood urea nitrogen, blood creatinine, blood creatinine, blood urea nitrogen, blood creatinine, blood creatinine, blood urea nitrogen, blood creatinine, blood creatinine, urea nitrogen, urea nitrogen, blood creatinine. The main effect of cystatin C was significant (P0.05N). The main effect of CBP on blood potassium was not significant. The blood urea nitrogen, serum creatinine and cystatin C in CBP group were lower than those in P0.05 CBP group before treatment for one week, and the levels of blood potassium, urea nitrogen and serum creatinine in CBP group were lower than those in CBP group before treatment. Cystatin C was lower than that before treatment (P 0.05), blood sodium in the medical treatment group was higher than that before treatment for 1 week, and urea nitrogen in the treatment group was higher than that before treatment. Serum creatinine was lower than that before treatment (P 0.05). There was interaction between treatment methods and time on TNF- 伪 -TNF- 伪, IL-10 and IL-10. The main effect of treatment on TNF- 伪 -IL-6IL-10 was significantly higher than that on TNF- 伪 IL-6IL-10, and the time of treatment on TNF- 伪 IL-6IL-10 was significantly lower than that on TNF- 伪 IL-6IL-10 in the treatment group at 24 h after treatment, the level of TNF- 伪 was lower than that of TNF- 伪 IL-6. Before treatment, the total effective rate of TNF- 伪 IL-6IL-10 in CBP group was significantly lower than that in CBP group before treatment for 48 h. Conclusion the total effective rate of TNF- 伪 IL-6IL-10 in CBP group is higher than that in internal medicine group. Conclusion the clinical efficacy of CBP in the treatment of critically ill children with AKI is superior to that of comprehensive medical therapy. It can effectively regulate cytokines and correct the immune function of children.
【作者单位】：安徽省儿童医院肾内科;
【基金】：安徽省自然科学基金资助项目(1608085MH204)
【分类号】：R720.597

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