章柏平 郭剑

【摘要】 目的：研讨连续肾脏替代治疗严重脓毒症的效果及对炎性因子水平的影响。方法：随机从本院2016年5月-2018年7月收治的严重脓毒症患者中抽取80例进行讨论，按随机数字表法分组，其中40例接受血必净治疗（对照组），另40例在血必净治疗基础上再接受连续肾脏替代治疗（研究组）。观察比较两组治疗效果。结果：研究组治疗总有效率（95.00%）高于对照组（62.50%），差异有统计学意义（P<0.05）。两组治疗前各炎性因子比较，差异均无统计学意义（P>0.05）。治疗后，研究组高迁移率族蛋白B1（HMGB1）、肿瘤坏死因子α（TNF-α）、超敏C反应蛋白（hs-CRP）均低于对照组（P<0.05）。治疗前，两组CD14+、CD8+、CD4+、淋巴细胞计数比较，差异均无统计学意义（P>0.05）。治疗后，研究组CD14+、CD4+、淋巴细胞计数均高于对照组（P<0.05），而两组CD8+比较，差异无统计学意义（P>0.05）。结论：连续肾脏替代治疗严重脓毒症效果突出，且可显著改善其炎性因子水平和免疫指标，值得推广。

【关键词】 脓毒症; 连续肾脏替代治疗; 炎性因子; 免疫

【Abstract】 Objective：To discuss the effect of continuous renal replacement therapy on severe sepsis and its effect on level of inflammatory factors.Method：80 patients with severe sepsis treated in our hospital from May 2016 to July 2018 were randomly selected for discussion，and they were grouped by random number table method.Among them，40 cases were received Xuebijing treatment（control group），another 40 patients were received continuous renal replacement therapy on the basis of Xuebijing treatment（study group）.The treatment effect of the two groups were observed and compared.Result：The total effective rate of the study group（95.00%） was higher than that of the control group（62.50%），the difference was statistically significant （P<0.05）.The each inflammatory factors of the two groups before treatment were compared，the differences were not statistically significant（P>0.05）.After treatment，the high mobility group protein B1（HMGB1），tumor necrosis factor-α（TNF-α），hypersensitive C reactive protein（hs-CRP） in the study group were lower than those in the control group（P<0.05）.CD14+，CD8+，CD4+，lymphocyte counts of the two groups were compared before treatment，the differences were not statistically significant（P>0.05）.After treatment，CD14+，CD4+ and lymphocyte counts in the study group were higher than those in the control group（P<0.05），while there was no significant difference in CD8+ between the two groups（P>0.05）.Conclusion：The effect of continuous renal replacement therapy on severe sepsis was prominent.It can significantly improve the level of inflammatory factors and immune indicators，thus it is worth promoting.

【Key words】 Sepsis; Continuous renal replacement therapy; Inflammatory factors; Immunity

First-authors address：The 908th Hospital of Joint Logistic Support Force，Yingtan 335000，China

doi：10.3969/j.issn.1674-4985.2019.17.028

膿毒症属于一种持久性、失控的炎性反应，会大量分泌出炎性介质，因病情逐步发展，机体会处于免疫抑制状态，加大病原体易感性。若不接受有效诊治，疾病会导致多脏器功能障碍综合征和休克等。大约有50%的肾功能衰竭患者均因继发脓毒症而发病[1]。近年来，连续肾脏替代治疗已在严重脓毒症疾病中得到广泛应用。且有研究报告明确指出，连续肾脏替代治疗严重脓毒症，可显著改善其炎性因子，提升疗效。为此，本研究共纳入本院以往收治的80例严重脓毒症患者分组，重点讨论连续肾脏替代治疗优势。现报道如下。

1 资料与方法

1.1 一般资料 随机从本院2016年5月-2018年7月收治的严重脓毒症患者中抽取80例进行讨论，纳入标准：（1）均满足《中国严重脓毒症/脓毒性休克治疗指南（2014）》中严重脓毒症血症诊治指南[2];（2）病历资料齐全。……