李代彪;陈晓华;
LI Daibiao;CHEN Xiaohua;Emergency Department, Nanchong Central Hospital;Intensive Care Unit, Nanchong Central Hospital;

• 1:南充市中心医院急诊科
• 2:南充市中心医院重症监护室

摘要(Abstract)：

目的:探讨连续性肾替代治疗(CRRT)对严重创伤后急性肾损伤(AKI)患者的干预效果。方法:严重创伤后AKI患者160例随机均分为实验组与对照组,2组患者入院后均给予手术及对症综合治疗,实验组还给予CRRT治疗、治疗时间>24 h;于治疗前后,比较2组患者肾功能指标血肌酐(Scr)及尿素氮(BUN),凝血功能指标[凝血酶原时间(PT)、凝血时间(TT)、活化部分凝血酶时间(APTT)及纤维蛋白原(FIB)],血及尿中AKI标记物肝型脂肪酸结合蛋白(sL-FABP、uL-FABP)水平,检测血清炎性因子白细胞介素-6(IL-6)、IL-10、IL-1β和肿瘤坏死因子-α(TNF-α)水平。结果:与治疗前比较,治疗后实验组患者血清Scr、BUN及sL-FABP、uL-FABP水平均明显降低,对照组患者上述指标水平均明显升高(P<0.05),且实验组明显低于对照组(P<0.01);与治疗前比较,治疗后实验组患者PT、TT及APTT均明显延长,且明显长于对照组(P<0.01);血清FIB水平明显降低、且明显低于对照组(P<0.01),对照组患者上述指标均无明显变化(P>0.05);与治疗前比较,治疗后实验组患者血清IL-10水平明显升高、且明显高于对照组(P<0.05),TNF-α水平明显降低、且明显低于对照组(P<0.05);实验组患者血清IL-6、IL-1β及对照组上述炎性因子水平均无明显变化(P>0.05)。结论:CRRT可清除部分严重创伤后AKI患者机体促炎因子、降低血及尿中AKI标记物sL-FABP和uL-FABP、改善患者肾功能,但CRRT过程中应及时监测患者凝血功能以预防出血。
Objective: To explore the intervention effect of continuous renal replacement therapy(CRRT) on patients with acute kidney injury(AKI) after severe trauma. Methods: 160 patients with AKI after severe trauma in our hospital from January 2016 to January 2017 were selected and randomly divided into the experiment group and the control group, 80 cases in each group. All patients were given comprehensive treatment after admission, and the experiment group was given CRRT on the base of the control group, the treatment time exceeded 24 h. The renal function, coagulation function, the levels of serum inflammatory factors and blood/urine AKI markers were compared before and after treatment in the 2 groups. Results: Compared with those before treatment, the levels of serum Scr, BUN and sL-FABP, uL-FABP after treatment in the experiment group decreased significantly, and the levels of above-mentioned indicators in the control group increased significantly(P<0.05 or P<0.01), and the experiment group was significantly lower than that of the control group(P<0.01). Compared with those before treatment, the PT, TT, and APTT after treatment in the experiment group significantly prolonged, and they were significantly longer than those of the control group(P<0.01), the level of serum FIB significantly decreased, and which was significantly lower than that of the control group(P<0.01); there was no significant change of the above-mentioned indicators in the control group(P>0.05). Compared with before treatment, the level of serum IL-10 in the experiment group significantly increased, and which was significantly higher than that of the control group(P<0.05); the level of TNF-α significantly decreased, and which was significantly lower than that of the control group(P<0.05 or P<0.01); there was no significant change of the levels of serum IL-6, IL-1β in the experiment group and the levels of above-mentioned indicators in the control group(P>0.05). Conclusion: CRRT can partially eliminate proinflammatory cytokines in patients with AKI after severe trauma, improve renal function, and effectively reduce the levels of blood/urine AKI markers, but during the CRRT process, the coagulation function of patients should be monitored in time to prevent bleeding.

关键词(KeyWords)： 肾替代疗法;创伤;急性肾损伤;肾功能试验;凝血功能;炎性因子;肝型脂肪酸结合蛋白
renal replacement therapy;trauma;acute kidney injury;renal function test;coagulation function;inflammatory factors;liver type fatty acid binding protein

Abstract:

Keywords:

基金项目(Foundation): 四川省卫生和计划生育委员会科研课题(2016Q3125)

作者(Authors): 李代彪;陈晓华;
LI Daibiao;CHEN Xiaohua;Emergency Department, Nanchong Central Hospital;Intensive Care Unit, Nanchong Central Hospital;

DOI: 10.19367/j.cnki.1000-2707.2019.06.024

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