本文關(guān)鍵詞：益氣溫陽補(bǔ)腎法聯(lián)合CRRT干預(yù)膿毒癥急性腎功能損害的臨床研究　出處：《南京中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 膿毒癥 急性腎功能損害 MODS SOFA CRRT IL-6 IL-10 TNF-α Scr Cys-C

【摘要】：目的：探討益氣溫陽補(bǔ)腎法聯(lián)合CRRT對膿毒癥急性腎功能損害患者的療效。方法：收入2014年4月至2015年01月入住江蘇省中醫(yī)院ICU符合膿毒癥合并急性腎功能損害(AKI)診斷標(biāo)準(zhǔn)的67名患者。67例患者中有21例拒絕行CRRT治療,歸為非CRRT組,并將其隨機(jī)分為兩個(gè)亞組常規(guī)治療組(n=10,僅接受常規(guī)治療)和中藥治療組(n=11,在常規(guī)治療的基礎(chǔ)上加用益氣溫陽補(bǔ)腎湯劑治療)。46例患者同意CRRT治療,歸為CRRT組,并將其隨機(jī)分為兩個(gè)亞組單純CRRT組(n=23,在常規(guī)治療的基礎(chǔ)上加用CRRT治療)和CRRT+中藥組(n=23,在常規(guī)治療的基礎(chǔ)上加用CRRT和益氣溫陽補(bǔ)腎湯劑聯(lián)合治療)。通過評價(jià)血清IL-6、IL-10和’TNF-a的水平變化以及序貫器官衰竭評分(SOFA)、氧合指數(shù)(OI)、平均動(dòng)脈壓(MAP)、血肌酐Scr、Cys-C,評價(jià)益氣溫陽補(bǔ)腎法聯(lián)合CRRT療法對膿毒癥合并急性腎損害患者的療效。結(jié)果：1：IL-6：各組血清IL-6水平在治療前無統(tǒng)計(jì)學(xué)差異(P0.05)。治療后3d,各組血清IL-6水平較治療前均出現(xiàn)不同程度下降,CRRT組(t=2.980,P=0.003)和CRRT+中藥組(t=3.424,P=0.001)最為明顯。而在治療后7d時(shí),CRRT+中藥組血清IL-6水平下降最為明顯(1=4.554, P0.001 vs治療后3d;t=3.457, P=0.002 vs單純CRRT組治療后7d)。2：IL-10：各組血清IL-10水平在治療前無統(tǒng)計(jì)學(xué)差異(P0.05)。治療后3d各組血清IL-10水平較治療前也無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。治療后7d,可見CRRT中藥組患者血清IL-10水平較治療前明顯升高(t=2.980,P=0.003 vs.治療后3d；t=2.345,P=0.013vs.單純CRRT組治療后7d)。3:TNF-a:各組血清TNF-a水平在治療前無統(tǒng)計(jì)學(xué)差異(P0.05)。治療3d后,各組血清TNF-a水平較治療前均出現(xiàn)不同程度下降,但未見明顯統(tǒng)計(jì)學(xué)差異(P0.05)。治療后7d,各組血清TNF-a水平較治療前均出現(xiàn)不同程度下降(常規(guī)治療組：t=1.987,P=0.028；中藥組：t=1.986,P=0.028,；單純CRRT組：1=2.433, P=0.010; CRRT+中藥組：t=2.356, P=0.012), CRRT組和CRRT+中藥組最為明顯。而在治療后7d時(shí),CRRT+中藥組血清TNF-a水平下降最為明顯(t=1.768, P=0.043 vs治療后3d)。4：OI:各組患者氧合指數(shù)OI在治療前均無統(tǒng)計(jì)學(xué)差異(P0.05)。治療后,在治療3d后,單純CRRT組(t=1.768,P=0.043)和CRRT+中藥組(t=1.768,P=0.043)患者0I明顯上升,而在治療后7d,四組患者OI水平均較治療前明顯上升(常規(guī)治療組：t=1.758,P=0.044；中藥組：t=1.955,P=0.030,；單純CRRT組：t=1.933,P=0.031;CRRT+中藥組：t=2.155,P=0.019),其中CRRT+中藥組明顯優(yōu)于單純CRRT組(t=2.365,P=0.010)。而CRRT+中藥組患者在治療7d后較治療3d時(shí)OI水平上升幅度更快(t=2.363,P=0.012)。5：MAP：各組患者平均動(dòng)脈壓MAP在治療前均無統(tǒng)計(jì)學(xué)差異(P0.05)。在治療3d后,僅CRRT+中藥組患者M(jìn)AP明顯上升(t=1.957,P=0.032),而在治療后7d,四組患者OI水平均較治療前明顯上升(常規(guī)治療組：t=1.901,P=0.040；中藥組：t=1.755,P=0.044,；單純CRRT組：t=2.133,P=0.018;CRRT+中藥組：t=2.187,P=0.017)。6：Scr:各組患者血肌酐Scr水平在治療前均無統(tǒng)計(jì)學(xué)差異(P0.05)。在治療3d后,CRRT組和CRRT+中藥組患者Scr水平明顯回落(t=2.702,P=0.002),而在治療后7d,四組患者Scr水平均較治療前明顯回落(常規(guī)治療組：t=1.702,P=0.047；中藥組：t=2.221,P=0.017,；單純CRRT組：t=2.185,P=0.016；CRRT+中藥組：t=2.567,P=0.007)。7:Cys-C:各組患者血Cys-C水平在治療前均無統(tǒng)計(jì)學(xué)差異(P0.05)。在治療3d后,各組患者血Cys-C水平均有不同程度回落,但未見統(tǒng)計(jì)學(xué)差異(P0.05),而在治療后7d,單純CRRT組和CRRT4中藥組患者血Cys-C水平均較治療前明顯回落(t=2.112,P=0.021),但與治療后3d比較,未見明顯統(tǒng)計(jì)學(xué)差異(t=1.789,P=0.042)。8:SOFA:各組治療前SOFA評分無統(tǒng)計(jì)學(xué)差異(P0.05),治療后3d可見CRRT組(t=1.754,P=0.043)和CRRT+中藥組(t=2.002,P=0.027)SOFA評分均顯著下降。治療后7d各組SOFA評分均較治療前顯著下降(常規(guī)治療組：t=1.874,P=0.036;中藥組：t=2.531,P=0.011,；單純CRRT組：t=2.147,P=0.023；CRRT+中藥組：t=2.548,P=0.008)。9：死亡風(fēng)險(xiǎn)的評估：COX回歸分析顯示膿毒癥急性腎損傷患者使用CRRT治療后,較非CRRT組患者的預(yù)后明顯改善。接受CRRT治療患者入ICU第3、7、14、30天死亡風(fēng)險(xiǎn)分別降低12%,5%,10%和3%,而第3天和第14天結(jié)果存在統(tǒng)計(jì)學(xué)差異(P3d=0.02,P14d=0.01)。同時(shí)cOx回歸分析顯示接受CRRT治療的患者患者聯(lián)合使用中藥治療后,較單純CRRT治療的預(yù)后有一定的優(yōu)勢,入院第3天和30天死亡風(fēng)險(xiǎn)降低9%和16%,而入院7天和14天死亡率增加分別2%和1%,其中第14天和第30天有統(tǒng)計(jì)學(xué)意義(P14d=0.04, P30d=0.03)。結(jié)論：益氣溫陽補(bǔ)腎法聯(lián)合CRRT更具有優(yōu)勢,比單純CRRT療法能更有效清除炎癥介質(zhì),阻斷炎性反應(yīng)的瀑布樣效應(yīng),改善組織灌注及氧合,有效保護(hù)臟器功能,尤其能夠減少腎功能損害,有助于腎功能的早期恢復(fù),從而改善患者預(yù)后并降低死亡率,對膿毒癥合并急性腎功能損害的患者療效確切。此研究對中醫(yī)藥在危重患者臨床救治中的作用和地位作出了肯定,也為更深層次研究奠定了一定的基礎(chǔ)。
[Abstract]:Objective: To investigate the effect of Yiqi Wenyang Bushen recipe combined with the efficacy of CRRT in sepsis acute kidney injury patients. Methods: income from April 2014 to 2015 01 months in Jiangsu Province Traditional Chinese Medicine Hospital ICU with acute kidney injury in patients with sepsis (AKI) in 67 patients with.67 patients with diagnostic criteria in 21 cases refused to underwent the treatment of CRRT. For non CRRT group, and were randomly divided into two sub groups: conventional treatment group (n=10, only receiving routine treatment) and treatment group (n=11, on the basis of conventional therapy plus treatment with Tonifying Qi and warming yang and Tonifying Kidney Decoction).46 patients agreed to CRRT treatment, classified as group CRRT, and they were divided into two sub groups (n=23, CRRT group treated by CRRT on the basis of conventional treatment in Chinese medicine group (n=23) and CRRT+, with CRRT and Bushen Yiqi Wenyang decoction combined with treatment based on routine treatment). Through the evaluation of serum IL-6, IL-10 and TNF-a level Change and sequential organ failure assessment (SOFA), oxygenation index (OI), mean arterial pressure (MAP), serum creatinine Scr, Cys-C, evaluation of Yiqi Wenyang Bushen recipe combined with CRRT therapy with curative effect in patients with acute kidney injury in sepsis patients. Results: 1:IL-6: there was no significant difference in the serum level of IL-6 in the treatment group the 3D (P0.05). After treatment, the serum levels of IL-6 group before treatment were decreased, CRRT group (t=2.980, P=0.003) and CRRT+ of Chinese medicine group (t=3.424, P=0.001) is the most obvious. And after treatment 7d, CRRT+ of Chinese medicine group serum IL-6 level decreased significantly (1=4.554, P0.001 after the treatment of vs 3D t=3.457, P=0.002 vs; CRRT group after treatment 7d.2:IL-10): there was no significant difference in the serum levels of IL-10 group before treatment (P0.05). After treatment, the serum levels of IL-10 group 3D than before treatment had no significant difference (P0.05). After the treatment of 7D, visible CRRT traditional Chinese medicine group The level of serum IL-10 was significantly higher than that before treatment (t=2.980, P=0.003 vs. t=2.345, P=0.013vs. 3D after treatment; only after treatment in group CRRT, 7D) there was no significant difference in the serum level of TNF-a.3:TNF-a: in each group before treatment (P0.05). After 3D treatment, the serum levels of TNF-a group before treatment were decreased, but no significant the difference (P0.05). 7d after treatment, the serum levels of TNF-a group before treatment were decreased (conventional treatment group: t=1.987, P=0.028; Chinese medicine group: t=1.986, P=0.028, 1=2.433, CRRT group; P= 0.010; CRRT+ traditional Chinese medicine group: t=2.356, P=0.012), CRRT group and CRRT+ group for the traditional Chinese medicine obviously. After treatment 7d, CRRT+ of Chinese medicine group serum TNF-a level decreased significantly (t=1.768, P=0.043, vs after treatment in.4:OI: group 3D) oxygenation index in patients with OI before treatment had no statistically significant difference (P0.05). After the treatment, in the treatment of After 3D treatment, CRRT group (t=1.768, P=0.043) and CRRT+ of Chinese medicine group (t=1.768, P=0.043) in patients with 0I significantly increased in 7d after treatment, patients with OI levels of the four groups were significantly increased than before treatment (routine treatment group: t=1.758, P=0.044; Chinese medicine group: t=1.955, P=0.030; CRRT group: t=1.933, P=0.031; CRRT+: t=2.155 P=0.019), Chinese medicine group, the CRRT+ traditional Chinese medicine group was significantly better than group CRRT (t=2.365, P=0.010). The CRRT+ traditional Chinese medicine in the treatment of patients after 7d treatment than 3D when OI levels rise faster (t=2.363, P=0.012).5:MAP: the changes of mean arterial pressure in patients with MAP before treatment had no statistical difference (P0.05). In the treatment of 3D, only CRRT+ of Chinese medicine group were significantly increased MAP (t=1.957, P=0.032), and in patients with 7d after treatment, OI levels of the four groups were significantly increased than before treatment (routine treatment group: t=1.901, P =0.040; Chinese medicine group: t=1.755, P=0.044, CRRT group; : t=2.133, P=0.018; CRRT+ t=2.187 P=0.017), Chinese medicine group:.6:Scr: blood creatinine level in patients with Scr were no significant difference before treatment (P0.05). In the treatment of 3D, CRRT group and CRRT+ group Scr levels dropped significantly (t=2.702, P=0.002), and at 7d after treatment, patients with Scr levels in the four groups there were significantly lower (conventional treatment group: t=1.702, P=0.047; Chinese medicine group: t=2.221, P=0.017, CRRT group: t=2.185; P=0.016; CRRT+ traditional Chinese medicine group: t=2.567, P=0.007) Cys-C level of patients with.7:Cys-C: in both groups had no significant difference before treatment (P0.05). In the treatment of 3D, Cys-C levels were the blood groups of different degrees of decline, but there was no statistical difference (P0.05), and at 7d after treatment, CRRT group and CRRT4 group serum Cys-C levels were significantly lower (t=2.112, P=0.021), but after treatment with 3D comparison, no statistically significant The difference (t=1.789, P=0.042).8:SOFA: groups before treatment SOFA score was no significant difference (P0.05), 3D after treatment in CRRT group (t=1.754, P=0.043) and CRRT+ of Chinese medicine group (t=2.002, P=0.027) SOFA scores were significantly decreased after treatment. 7d SOFA score were significantly lower than before treatment (routine treatment group: t=1.874. P=0.036; Chinese medicine group: t=2.531, P=0.011, CRRT group: t=2.147; P=0.023; CRRT+ traditional Chinese medicine group: t=2.548, P=0.008).9: assessment of the risk of death: COX regression analysis showed that patients with sepsis induced acute kidney injury after treatment of CRRT, compared with non CRRT group patients had significantly improved prognosis. Patients treated with CRRT ICU day 3,7,14,30 the risk of death was decreased by 12%, 5%, 10% and 3%, while the third and fourteenth day results there were significant differences (P3d=0.02, P14d=0.01). COx regression analysis showed that patients treated with CRRT in patients with combined treatment of traditional Chinese medicine, There are some advantages in treatment and prognosis compared with CRRT alone, on the third day and 30 day mortality risk decreased by 9% and 16%, and on the 7 day and 14 day mortality increased 2% and 1% respectively, which was significant in the fourteenth and thirtieth days (P14d=0.04, P30d=0.03). Conclusion: Yiqi Wenyang Bushen recipe combined with CRRT is more the advantages, compared with the simple CRRT therapy can effectively remove inflammatory mediators, blocking the waterfall like effect of inflammatory reaction, improve tissue perfusion and oxygenation, effective protection of organ function, especially can reduce renal damage, contributes to recovery of renal function in the early stage, so as to improve the prognosis and reduce mortality in patients with acute renal function the damage of sepsis. The study on the exact and status of TCM in clinical treatment of critically ill patients in the role of the affirmative, but also for the deeper research has laid a foundation.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.7

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