连续性肾脏替代治疗对老年脓毒症患者肠功能、免疫功能和预后转归的影响

发布时间：2018-05-27 02:14

  本文选题：脓毒症 + 连续性肾脏替代治疗　； 参考：《山东医药》2017年10期

【摘要】：目的观察连续性肾脏替代治疗(CRRT)对老年脓毒症患者的肠功能、免疫功能和预后转归的影响。方法将200例老年脓毒症患者随机分为观察组及对照组各100例,两组均在治疗相关基础病的同时给予抗炎、抑菌、补液、预防应激性溃疡、控制血糖等支持治疗,观察组同时行CRRT。治疗前和治疗第4周,观测患者腹部相关临床症状(腹痛、腹胀)、肠鸣音及排便情况,取血以流式细胞仪检测淋巴细胞、CD14~+单核细胞人类白细胞抗原DR(HLA-DR)及CD4~+、CD8~+T淋巴细胞亚群,行APACHEⅡ评分、多器官功能障碍综合征(MODS)评分,记录28 d内患者死亡情况。结果两组治疗后排便和肠鸣音次数均较治疗前增加(P均0.05),且观察组较对照组腹部相关临床症状减少、排便和肠鸣音次数增加(P均0.05)。治疗后两组外周血淋巴细胞计数、CD4~+T淋巴细胞比例、CD14~+单核细胞HLA-DR表达较治疗前增加(P均0.05),治疗后观察组外周血淋巴细胞计数、CD4~+T淋巴细胞比例、CD14~+单核细胞HLA-DR表达均高于对照组(P均0.05),但CD8~+T淋巴细胞比例变化不大(P0.05)。治疗后两组APACHEⅡ评分、MODS评分均较治疗前降低(P均0.05),且观察组低于对照组(P均0.05)。治疗后观察组28 d病死率为2%,低于对照组的10%(P0.05)。结论基础治疗联合CRRT治疗老年脓毒症患者可减少机体内炎症介质,提高免疫功能,降低疾病严重程度并改善预后。
[Abstract]:Objective to observe the effects of continuous renal replacement therapy (CRRT) on intestinal function, immune function and prognosis in elderly patients with sepsis. Methods 200 cases of senile sepsis were randomly divided into two groups: observation group (n = 100) and control group (n = 100). Both groups were treated with anti-inflammatory, bacteriostasis, fluid resuscitation, stress ulcer prevention and blood glucose control at the same time. CRRTT was performed at the same time in the observation group. The clinical symptoms (abdominal pain, abdominal distention, bowel sounds and defecation) were observed before and at the 4th week of treatment. The lymphocyte CD14 ~ monocyte HLA-DRN and CD4 ~ + CD8 ~ T lymphocyte subsets were detected by flow cytometry. APACHE 鈪，

本文编号：1939966