發(fā)布時(shí)間：2018-05-27 02:14

  本文選題：膿毒癥 + 連續(xù)性腎臟替代治療��； 參考：《山東醫(yī)藥》2017年10期

【摘要】：目的觀察連續(xù)性腎臟替代治療(CRRT)對(duì)老年膿毒癥患者的腸功能、免疫功能和預(yù)后轉(zhuǎn)歸的影響。方法將200例老年膿毒癥患者隨機(jī)分為觀察組及對(duì)照組各100例,兩組均在治療相關(guān)基礎(chǔ)病的同時(shí)給予抗炎、抑菌、補(bǔ)液、預(yù)防應(yīng)激性潰瘍、控制血糖等支持治療,觀察組同時(shí)行CRRT。治療前和治療第4周,觀測(cè)患者腹部相關(guān)臨床癥狀(腹痛、腹脹)、腸鳴音及排便情況,取血以流式細(xì)胞儀檢測(cè)淋巴細(xì)胞、CD14~+單核細(xì)胞人類(lèi)白細(xì)胞抗原DR(HLA-DR)及CD4~+、CD8~+T淋巴細(xì)胞亞群,行APACHEⅡ評(píng)分、多器官功能障礙綜合征(MODS)評(píng)分,記錄28 d內(nèi)患者死亡情況。結(jié)果兩組治療后排便和腸鳴音次數(shù)均較治療前增加(P均0.05),且觀察組較對(duì)照組腹部相關(guān)臨床癥狀減少、排便和腸鳴音次數(shù)增加(P均0.05)。治療后兩組外周血淋巴細(xì)胞計(jì)數(shù)、CD4~+T淋巴細(xì)胞比例、CD14~+單核細(xì)胞HLA-DR表達(dá)較治療前增加(P均0.05),治療后觀察組外周血淋巴細(xì)胞計(jì)數(shù)、CD4~+T淋巴細(xì)胞比例、CD14~+單核細(xì)胞HLA-DR表達(dá)均高于對(duì)照組(P均0.05),但CD8~+T淋巴細(xì)胞比例變化不大(P0.05)。治療后兩組APACHEⅡ評(píng)分、MODS評(píng)分均較治療前降低(P均0.05),且觀察組低于對(duì)照組(P均0.05)。治療后觀察組28 d病死率為2%,低于對(duì)照組的10%(P0.05)。結(jié)論基礎(chǔ)治療聯(lián)合CRRT治療老年膿毒癥患者可減少機(jī)體內(nèi)炎癥介質(zhì),提高免疫功能,降低疾病嚴(yán)重程度并改善預(yù)后。
[Abstract]:Objective to observe the effects of continuous renal replacement therapy (CRRT) on intestinal function, immune function and prognosis in elderly patients with sepsis. Methods 200 cases of senile sepsis were randomly divided into two groups: observation group (n = 100) and control group (n = 100). Both groups were treated with anti-inflammatory, bacteriostasis, fluid resuscitation, stress ulcer prevention and blood glucose control at the same time. CRRTT was performed at the same time in the observation group. The clinical symptoms (abdominal pain, abdominal distention, bowel sounds and defecation) were observed before and at the 4th week of treatment. The lymphocyte CD14 ~ monocyte HLA-DRN and CD4 ~ + CD8 ~ T lymphocyte subsets were detected by flow cytometry. APACHE 鈪，

本文編號(hào)：1939966