李敏雄+++黄永鹏　叶燕红　伍增龙　庞荣锋　范小龙

[摘要] 目的 比较连续性肾脏替代治疗（CRRT）与常规疗法对重症感染引起急性肾损伤患者临床效果及血清炎性介质的影响。 方法 将2015年8月～2016年8月广东省佛山市高明区人民医院收治的70例重症感染引起急性肾损伤患者，随机分为两组，各75例。对照组患者给予常规治疗，观察组患者给予CRRT。比较两组患者治疗前后的肾功能指标、血清炎性因子水平、病死率及急性生理与慢性健康Ⅱ（APACHEⅡ）评分。 结果 观察组治疗后的血肌酐、血尿素氮、血钾和血乳酸水平明显低于治疗前和对照组治疗后（P < 0.05）；观察组治疗后的肿瘤坏死因子-α、白介素-4、白介素-6和白介素-10水平明显低于治疗前和对照组治疗后（P < 0.05）；治疗后观察组患者的病死率及APACHEⅡ评分明显低于对照组（P < 0.05）。 结论 CRRT可明显改善重症感染引起急性肾损伤患者的肾功能指标和血清炎性因子水平，降低病死率。

[关键词] 连续性肾脏替代疗法；重症感染；急性肾损伤；血清炎性因子

[中图分类号] R567 [文献标识码] A [文章编号] 1673-7210（2016）12（a）-0081-04

Clinical effect of continuous renal replacement therapy for patients with acute kidney injury caused by severe infections

LI Minxiong HUANG Yongpeng YE Yanhong WU Zenglong PANG Rongfeng FAN Xiaolong

Department of Intensive Care Unit， Gaoming People's Hospital of Foshan， Guangdong Province， Foshan 528500， China

[Abstract] Objective To compare the inflerence of continuous renal replacement therapy and conventional therapy on clinical effect and serum inflammatory factors of patients with acute kidney injury caused by severe infections. Methods From August 2015 to August 2016， in Gaoming People's Hospital of Foshan， 70 patients with acute kidney injury caused by severe infections were divided into two groups randomly， each group had 35 cases. The control group was given conventional therapy and the observation group was given continuous renal replacement therapy. The renal function index， inflammatory factor levels， mortality rate and acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） scores of patients in two groups were compared. Results Serum creatinine， blood urea nitrogen， blood potassium and blood lactic acid in the observation group after treatment were significantly lower than before treatment and the control group after treatment （P < 0.05）. The levels of TNF-α， IL-4， IL-6 and IL-10 in the observation group after treatment were significantly lower than before treatment and the control group after treatment （P < 0.05）. Mortality rate and APACHEⅡ scores in the observation group after treatment were significantly lower than the control group after treatment （P < 0.05）. Conclusion Continuous renal replacement therapy can effectively improve renal function index， inflammatory factor levels and reduce mortality rate.

[Key words] Continuous renal replacement therapy； Severe infections； Acute kidney injury； Serum inflammatory factor

重癥感染引起的急性肾损伤有较高的病死率，主要与患者的免疫功能极为低下有关，特别是感染会加重患者的病情，其中肺部感染是目前临床上较为多见和凶险的一种感染，会导致患者出现严重的炎性反应。降低严重感染合并急性肾损伤患者病死率的关键是早诊断、早治疗[1-3]。目前，对于重症感染引起急性肾损伤的治疗主要包括抗感染治疗、呼吸支持治疗、连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）等，特别是CRRT的应用较为广泛，可达到改善预后、降低病死率的目的，其主要机制是有效地清除炎症因子，减轻炎性反应[4-5]。本研究对2015年8月～2016年8月广东省佛山市高明区人民医院（以下简称“我院”）收治的70例重症感染引起急性肾损伤患者，分别给予常规……