本文選題：局部枸櫞酸抗凝(RCA)　切入點(diǎn)：膿毒癥急性腎損傷(SAKI)　出處：《生物醫(yī)學(xué)工程與臨床》2017年03期 　論文類型：期刊論文

【摘要】：目的對(duì)比研究局部枸櫞酸抗凝(RCA)與全身肝素抗凝對(duì)膿毒癥急性腎損傷(SAKI)行連續(xù)性靜脈-靜脈血液濾過(CVVH)患者免疫功能的影響。方法選擇南京醫(yī)科大學(xué)附屬無錫市人民醫(yī)院2012年2月至2016年4月確診的70例SAKI患者進(jìn)行前瞻性研究,其中男性40例,女性30例;年齡36~82歲,平均年齡56.32歲。原發(fā)病:重癥肺炎42例,急性重癥胰腺炎12例,急性膽管炎10例,急性彌漫性腹膜炎6例�；颊唠S機(jī)分為全身肝素抗凝組(A組,34例)和RCA組(B組,36例),兩組患者均行CVVH 48 h。分別觀察兩組患者CVVH治療0、12、24、48 h白介素-6(IL-6)、腫瘤壞死因子-α(TNF-α)水平,并監(jiān)測(cè)兩組CVVH治療0 h和48 h CD3~+百分比、CD4~+百分比、CD4~+/CD8~+比值的變化。比較兩組濾器使用壽命、28 d病死率。結(jié)果兩組患者CVVH治療12 h和24 h,A組IL-6值、TNF-α值均高于B組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。CVVH治療48 h A組CD3+百分比、CD4~+百分比、CD4~+/CD8~+比值顯著低于B組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。此外,A組濾器使用壽命(25.86±7.32)h,顯著低于B組[(39.80±4.68)h],A組28 d病死率(48.72%)顯著高于B組(29.56%),差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論與全身肝素抗凝比較,SAKI患者CVVH時(shí)使用RCA,能更有效清除炎性因子及調(diào)節(jié)患者T淋巴細(xì)胞亞群免疫穩(wěn)態(tài),改善患者預(yù)后。
[Abstract]:Objective to compare the effects of local anticoagulant citrate (RCA) and systemic heparin anticoagulation on immune function of patients with septic acute renal injury (SAKI) undergoing continuous veno-venous hemofiltration (CVVH). Methods Wuxi City affiliated to Nanjing Medical University was selected. A prospective study was conducted in 70 patients with SAKI diagnosed in the people's Hospital from February 2012 to April 2016. There were 40 males and 30 females, aged 36 to 82 years, with an average age of 56.32. The primary diseases were severe pneumonia (42 cases), severe acute pancreatitis (12 cases), acute cholangitis (10 cases). 6 cases of acute diffuse peritonitis were randomly divided into two groups: systemic heparin anticoagulant group (group A, n = 34) and RCA group (n = 36, group B, n = 36). The patients in both groups were treated with CVVH for 48 h. The levels of interleukin-6 sil 6 and tumor necrosis factor- 偽 TNF- 偽 were observed in two groups of patients treated with CVVH for 24 48 h. The changes of CD4 ~% CD4 ~% CD4- / CD8- / CD4- / CD8- / CD4- / CD8- / CD4- / CD8- / CD4- / CD8- / CD4-% ratio in two groups were monitored after 0 h and 48 h of CVVH treatment. The mortality of the two groups was compared. Results the IL-6 value of group A was higher than that of group B at 12 h and 24 h after CVVH treatment. All the differences were statistically significant. The percentage of CD3 in group A was significantly lower than that in group B after 48 h treatment. In addition, the service life of filter in group A was 25.86 鹵7.32 hs, which was significantly lower than that in group B [39.80 鹵4.68 h] and the fatality rate in group A was significantly higher than that in group B in 28 days. The difference was significant (P0.055.Conclusion compared with systemic heparin anticoagulant, SAKI patients were treated with CVVH. RCA can effectively remove inflammatory factors and regulate the immune homeostasis of T lymphocyte subsets in patients. To improve the prognosis of patients.
【作者單位】： 南京醫(yī)科大學(xué)附屬無錫市人民醫(yī)院重癥醫(yī)學(xué)科;
【分類號(hào)】：R459.7;R692

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