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目的探讨高容量连续性血液净化(CBP)治疗对脓毒血症致早期急性肾损伤(AKI)患者的疗效及对免疫功能的影响。方法选择60例脓毒血症致早期AKI患者随机进行高容量(70ml·kg-1·h-1)、标准容量(35ml·kg-1·h-1)连续性静脉-静脉血液滤过(CVVH)治疗,动态观察APACHEⅡ、SOFA评分及细胞因子IL-6、TNF-α的变化,比较两组的转归及对炎症因子的影响。结果和标准容量组比较,高容量组存活率明显增高,肾功能恢复时间明显缩短,APACHEⅡ、SOFA评分下降早且幅度大,两组治疗前TNF-α、IL-6均较正常人显著升高,治疗后高容量组TNF-α、IL-6水平下降早且显著,差异均有统计学意义(P<0.05或<0.01)。结论高容量CBP技术在脓毒血症致早期AKI患者中的应用能更好地清除炎症细胞因子,降低病死率,促进肾功能恢复。
Objective To investigate the effect of high-volume continuous blood purification (CBP) therapy on immune function in sepsis-induced acute kidney injury (AKI) patients. Methods Sixty patients with early AKI induced by sepsis were randomly divided into two groups: high volume (70ml · kg-1 · h-1) and standard volume (35ml · kg-1 · h-1) continuous veno-venous hemofiltration CVVH). The changes of APACHEⅡ, SOFA score, cytokines IL-6 and TNF-α were observed dynamically. The outcome of the two groups and the influence on the inflammatory factors were compared. Results Compared with the standard volume group, the survival rate of high-capacity group was significantly increased, and the recovery time of renal function was significantly shortened. APACHEⅡ and SOFA scores decreased earlier and larger, and the levels of TNF-α and IL-6 in two groups were significantly higher than those in normal group After treatment, the levels of TNF-α and IL-6 in high-volume group decreased significantly and earlier, with significant difference (P <0.05 or <0.01). Conclusion The application of high-volume CBP in early AKI induced by sepsis can better eliminate inflammatory cytokines, reduce mortality and promote recovery of renal function.