摘要
目的 探讨碳酸氢钠林格液(BRS)联合连续性肾脏替代疗法(CRRT)对创伤合并急性肾损伤(AKI)患者炎症水平及肾功能的影响.方法 收集2020年4月至2022年4月收治的57例创伤合并AKI患者,分为观察组(29例)和对照组(28例).观察组采用BRS联合CRRT治疗,对照组采用乳酸钠林格液联合CRRT治疗.比较两组患者治疗前后白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、肌酐、尿素氮、乳酸变化情况,并记录两组患者治愈情况.结果 两组患者治疗前WBC(Z=1.269,P=0.204)、PCT(Z=0.471,P=0.638)、CRP(Z=1.493,P=0.135)、IL-6(t=1.870,P=0.067)、TNF-α(t=0.961,P=0.341)、肌酐(t=1.701,P=0.095)、尿素氮(t=1.137,P=0.260)、乳酸(t=0.239,P=0.812)水平比较,差异均无统计学意义.治疗后,观察组及对照组的WBC(Z=4.703、3.196,P均＜0.001)、PCT(Z=4.320、4.020,P均＜0.001)、CRP(Z=4.620、4.540,P 均＜0.001)、肌酐(t=6.560、6.588,P 均＜0.001)、尿素氮(t=4.877、4.022,P均＜0.001)、乳酸(t=5.852、6.073,P均＜0.001)水平均较治疗前显著下降,且观察组CRP水平较对照组下降更为明显(Z=5.092,P＜0.001);观察组IL-6(t=4.619,P＜0.001)、TNF-α(t=3.099,P=0.004)水平较治疗前均显著下降,且观察组 IL-6(t=2.462,P=0.017)、TNF-α(t=2.404,P=0.019)水平均明显低于对照组.同时,观察组的治愈占比显著高于对照组(27/29 vs.20/28,x2=4.884,P=0.027).结论 采用BRS联合CRRT能够更有效地改善创伤合并AKI患者的肾功能,抑制炎症反应,提高患者的治愈情况.
Abstract
Objective To investigate the effect of sodium bicarbonate Ringer's solution(BRS)combined with continuous renal replacement therapy(CRRT)on the inflammation level and renal function in trauma patients with acute kidney injury(AKI).Methods A total of 57 trauma patients with AKI admitted from April 2020 to April 2022 were collected and divided into an observation group(29 cases)and a control group(28 cases).The observation group was treated with BRS combined with CRRT,and the control group was treated with the sodium lactated Ringer's solution combined with CRRT.The white blood cell count(WBC),procalcitonin(PCT),C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),creatinine,urea nitrogen(BUN)and lactic acid before and after treatment were compared between the two groups,and the healing status of patients in the two groups was recorded.Results The WBC(Z=1.269,P=0.204),PCT(Z=0.471,P=0.638),CRP(Z=1.493,P=0.135),IL-6(t=1.870,P=0.067),TNF-α(t=0.961,P=0.341),creatinine(t=1.701,P=0.095),BUN(t=1.137,P=0.260)and lactic acid(t=0.239,P=0.812)before treatment all showed no significant differences between the two groups.After treatment,the WBC(Z=4.703,3.196;both P＜0.001),PCT(Z=4.320,4.020;both P＜0.001),CRP(Z=4.620,4.540;both P＜0.001),creatinine(t=6.560,6.588;both P＜0.001),BUN(t=4.877,4.022;both P＜0.001)and lactic acid(t=5.852,6.073;both P＜0.001)in the observation group and control group were much lower than those before treatment,and the CRP level in the observation group was significantly lower than that in the control group(Z=5.092,P＜0.001).The levels of IL-6(t=4.619,P＜0.001)and TNF-α(t=3.099,P=0.004)in the observation group after treatment were much lower than those before treatment,and the levels of IL-6(t=2.462,P=0.017)and TNF-α(t=2.404,P=0.019)in the observation group also decreased markedly as compared with the control group.Meanwhile,the proportion of cure in the observation group was much higher than that in the control group(27/29 vs.20/28,x2=4.884,P=0.027).Conclusion BRS combined with CRRT can effectively improve the renal function,inhibit the inflammatory response and improve the cure status of trauma patients with AKI.
基金项目
中国初级卫生保健基金会临床科研专项资助项目(YLGX-JZ-2020011)
六安市人民医院2020年院级科研项目(2020kykt26)
NETL
NSTL
维普
万方数据