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目的:探讨中性大孔径树脂血液灌流联合连续性静脉-静脉滤过治疗脓毒症并发急性肾功能损伤的临床疗效。方法:120名脓毒症并发急性肾功能损伤的患者随机分成两组,每组60例。观察组采用中性大孔径树脂血液灌流联合连续性静脉-静脉滤过(NMRC-DHP+CVVH)治疗;对照组采用连续性静脉-静脉滤过(CVVH)治疗。使用ELISA方法对两组患者CRP、TNF-α、IL-6及IL-10水平进行检测,并对两组APACHEⅡ评分进行比较。结果:(1)治疗后3 d、7 d、14 d,两组CRP、TNF-α和IL-6较治疗前显著下降,P<0.05,而IL-10水平差异无统计学意义(P>0.05);同期比较,观察组CRP、TNF-α和IL-6水平均低于对照组,P<0.05,而IL-10水平无显著变化(P>0.05);(2)治疗后3 d、7 d、14 d,两组APACHE II评分较治疗前显著下降,P<0.05;同期比较,观察组APACHE II评分均低于对照组,P<0.05。结论:相对于单独采用CVVH,采用NMRC-DHP联合CVVH治疗脓毒症并发AKI能够更加有效清除炎症介质,促进肾功能的恢复,疗效确切,值得临床推广。
Objective: To investigate the clinical effect of hemoperfusion combined with macroporous resin and continuous veno-venous filtration in the treatment of sepsis complicated with acute renal injury. Methods: One hundred and seventy patients with sepsis and acute renal impairment were randomly divided into two groups (n = 60 in each group). The observation group was treated with macroporous resin hemoperfusion combined with continuous veno-venous filtration (NMRC-DHP + CVVH) and the control group with continuous veno-venous filtration (CVVH). The levels of CRP, TNF-α, IL-6 and IL-10 in the two groups were detected by ELISA, and APACHEⅡscores of the two groups were compared. Results: (1) The levels of CRP, TNF-α and IL-6 in the two groups decreased significantly at 3 d, 7 d and 14 d after treatment, P <0.05, while the levels of IL-10 were not significantly different (P> 0.05), while the level of IL-10 had no significant difference (P> 0.05); (3) The levels of CRP, TNF-α and IL-6 in the observation group were lower than those in the control group At 7 and 14 days, APACHE II scores decreased significantly in both groups (P <0.05). Compared with the control group, APACHE II scores in the observation group were lower than those in the control group (P <0.05). CONCLUSIONS: Compared with CVVH alone, the combination of NMRC-DHP and CVVH in the treatment of sepsis complicated with AKI can effectively remove the inflammatory mediators and promote the recovery of renal function. The curative effect is worthy of clinical promotion.