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目的探讨杂合式肾脏替代治疗对急性肾功能衰竭伴全身炎症反应综合征高龄患者的临床疗效。方法回顾性选取由重症肺炎、心脏疾病及脑血管意外引起的全身炎症反应综合征合并急性肾功能衰竭高龄患者38例,分为杂合式连续性静脉-静脉血液透析滤过联合血浆置换(CVVHDF-PE)组(n=20)及对照组(同时期患者或家属不愿接受血液净化治疗者,n=18),比较2种治疗方式对患者急性生理与慢性健康(APACHEⅡ)评分、血清肌酐(Scr)、白细胞介素10(IL-10)、IL-6、肿瘤坏死因子α(TNF-α)水平,血气分析指标,CD4~+T细胞、CD8~+T细胞数量,CD4~+/CD8~+T细胞比率及患者存活率的影响。结果与对照组相比,CVVHDF-PE组治疗后APACHEⅡ评分、Scr、IL-10、IL-6、TNF-α水平明显下降;p H值升高、p CO2升高、HCO3-升高;CVVHDF-PE组治疗后CD4~+T细胞、CD4~+/CD8~+T细胞比例较前显著升高,CD8~+T细胞较治疗前明显下降,对照组的上述免疫功能指标治疗前后无明显差异;CVVHDF-PE组存活率明显高于对照组。结论重症肺炎、心脏疾病及脑血管意外引起的全身炎症反应综合征合并急性肾功能衰竭时,在常规治疗基础上,尽早应用杂合式肾脏替代治疗能有效清除体内多种毒素及炎症介质,纠正酸碱平衡紊乱,改善免疫抑制状态及临床症状,提高对高龄患者的救治成功率。
Objective To investigate the clinical effect of heterozygous renal replacement therapy on elderly patients with acute renal failure and systemic inflammatory response syndrome. Methods A total of 38 elderly patients with systemic inflammatory response syndrome and acute renal failure caused by severe pneumonia, heart disease and cerebrovascular accident were retrospectively selected and divided into three groups: heterozygous continuous veno-venous hemodiafiltration combined with plasma exchange (CVVHDF- PE group (n = 20) and control group (n = 18 for those patients or their families unwilling to undergo blood purification treatment at the same time). The APACHE II scores, serum creatinine Scr, IL-10, IL-6, TNF-α, blood gas analysis, CD4 ~ + T cells, CD4 ~ + / CD8 ~ + T cell ratio and patient survival rate. Results Compared with the control group, APACHEⅡscore, Scr, IL-10, IL-6 and TNF-αlevel of CVVHDF-PE group decreased significantly; p H value increased, p CO2 increased and HCO3- increased; CVVHDF The proportion of CD4 ~ + T cells and CD4 ~ + / CD8 ~ + T cells in PE group increased significantly compared with those before treatment, and the levels of CD8 ~ + T cells decreased significantly compared with those before treatment. There was no significant difference in the above immune function indexes ; CVVHDF-PE group survival rate was significantly higher than the control group. Conclusion Severe pneumonia, heart disease and cerebrovascular accident caused by systemic inflammatory response syndrome with acute renal failure, based on conventional treatment, the early application of hybrid renal replacement therapy can effectively remove the body of a variety of toxins and inflammatory mediators to correct acid Alkali disorders, improve immune suppression and clinical symptoms, improve the success rate of treatment of elderly patients.