河北医学2018，Vol.24Issue(6)：923-927,5.DOI:10.3969/j.issn.1006-6233.2018.06.011
血清Cys C指导下肾替代治疗脓毒症合并多器官功能障碍综合征的疗效研究
Efficacy of Renal Replacement Therapy in Patients with Sepsis combined with MODS Guided by Serum Cys C
摘要
Abstract
Objective: To investigate the reference value of serum cystatin C ( Cys C) detection on the continuous renal replacement therapy time of the patients with sepsis combined multiple organ dysfunction syn-drome ( MODS) . Methods: 86 cases of sepsis combined with MODS were selected from June 2015 to August 2017 in our hospital with ICU. According to the time intervals between the time point of serum Cys C level be-gan to increase and the time point of continuous renal replacement therapy began, they were divided into group A (＜48h, 34 cases), group B (48～72h, 25 cases) and group C (＞72h, 27 cases). The changes of 24h vi-tal signs before and after continuous renal replacement therapy were recorded and compared, including heart rate, body temperature, APACHE Ⅱ score and SOFA score; 48h cardiac index (CI), stroke output index (SVI), mean arterial pressure (MAP) and peripheral vascular resistance index (SVRI) levels were moni-tored before treatment and after treatment; venous blood and arterial blood samples were taken before treatment and 48h after treatment, the contents of alanine aminotransferase ( ALT) , total bilirubin ( TBIL) , blood urea nitrogen ( BUN) , serum creatinine ( Scr) , blood lactate and procalcitonin ( PCT) were measured. Results:①Compared with before treatment, the 24h heart rate, body temperature, APACHE Ⅱ score and SOFA score of the three groups were significantly lower ( P＜0.05) after continuous renal replacement therapy. Compared with group B and C, the heart rate, body temperature, APACHE Ⅱ score and SOFA score in group A were significantly decreased (P＜0.05). ②Compared with before treatment, the 48h CI, SVI and MAP increased significantly ( P＜0.05) and SVRI significantly decreased ( P＜0.05) in the three groups after continuous renal replacement therapy. Compared with group B and C, the increase of CI, SVI and MAP was more significant (P＜0.05), and the decrease of SVRI was more significant (P＜0.05) in group A. ③Compared with before treatment, ALT, TBIL, BUN, Scr, blood lactic acid and PCT decreased significantly in the three groups at 48h after continuous renal replacement therapy (P＜0.05). Compared with group B and C, the decrease of ALT, TBIL, BUN, Scr, blood lactic acid and PCT in group A was more significant ( P＜0.05) . ④The time of continuous renal replacement therapy and the time of ICU hospitalization in group A were significantly less than those in group B ( P＜0.05) ; the time of continuous renal replacement therapy and the time of ICU hospitaliza-tion in group B were significantly less than those in group C ( P＜0.05) . The 4 weeks mortality rate in group A was lower than that in group B and group C, but the difference was not statistically significant (P＞0.05). Conclusion: Continuous renal replacement therapy within 48h of serum Cys C level may better control the condition of septic patients with MODS.关键词
脓毒症/多器官功能障碍综合征/连续肾替代治疗/胱抑素CKey words
Sepsis/Multiple organ dysfunction syndrome/Continuous renal replacement therapy/Cystatin C引用本文复制引用
陈瑞娟,付斌,吴泽,关小容,李兆..血清Cys C指导下肾替代治疗脓毒症合并多器官功能障碍综合征的疗效研究[J].河北医学,2018,24(6):923-927,5.基金项目
海南省海口市重点科技计划项目,(编号:2015-87) （编号:2015-87）
