摘要目的:探讨连续肾替代治疗脓毒症合并急性肾损伤的效果及对细胞炎性因子和肾功能影响。方法:选择江山市人民医院2017年1月至2019年10月收治的脓毒症合并急性肾损伤患者82例，依据随机数字表法分为对照组和观察组各41例。对照组给予常规治疗，观察组在对照组基础上联合连续性静脉-静脉血液滤过(CVVH)治疗。两组疗程均为5 d。比较两组重症监护室(ICU)入住时间和机械通气时间，治疗前后Marshall器官功能障碍评分和急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、细胞炎性因子和肾功能变化。结果:观察组ICU入住时间[(13.25±1.97)d]和机械通气时间[(11.83±2.43)d]均短于对照组[(11.83±2.43)d和(16.78±1.85)d]( t＝9.092、10.378，均 P<0.05)。观察组治疗后Marshall器官功能障碍评分[(5.78±0.81)分]和APACHEⅡ评分[(15.40±1.62)分]均低于对照组[(7.19±0.67)分和(21.25±3.25)分]( t＝8.589、10.315，均 P<0.05)。观察组治疗后血清降钙素原(PCT)[(7.68±2.10)μg/L]和C反应蛋白(CRP)[(45.41±10.20)mg/L]均低于对照组[(13.76±1.78)μg/L和(109.87±12.76)mg/L]( t＝14.142、25.266，均 P<0.05)。观察组治疗后尿素氮[(4.62±0.38)nmol/L]和肌酐[(25.45±5.17)μmol/L]均低于对照组[(13.79±0.43)nmol/L和(68.79±4.15)μmol/L]( t＝20.011、18.421，均 P<0.05)。 结论:连续肾替代治疗对脓毒症合并急性肾损伤效果良好，可明显减轻细胞炎性反应及改善患者肾功能。

abstractsObjective:To investigate the effect of continuous renal replacement therapy on sepsis complicated with acute renal injury and its influence on cytokines and renal function.Methods:From January 2017 to October 2019, 82 patients with sepsis and acute renal injury admitted to the People's Hospital of Jiangshan were divided into control group and observation group according to the random digital table, with 41 cases in each group.The control group was given routine treatment, and the observation group was treated with continuous veno venous hemofiltration(CVVH) on the basis of the control group.The course of treatment in both groups was 5 days.The time of ICU stay and mechanical ventilation, Marshall score, acute physiology and chronic health status scoreⅡ(APACHEⅡ), cytokines and renal function were compared before and after treatment.Results:The ICU stay time[(13.25±1.97)d] and mechanical ventilation time[(11.83±2.43)d] in the observation group were shorter than those in the control group[(11.83±2.43)d and (16.78±1.85)d]( t=9.092, 10.378, all P<0.05). After treatment, the Marshall organ dysfunction score[(5.78±0.81)points] and APACHEⅡ score[(15.40±1.62)points] in the observation group were lower than those in the control group[(7.19±0.67)points and (21.25±3.25)points]( t=8.589, 10.315, all P<0.05). The serum levels of PCT[(7.68±2.10)μg/L] and CRP[(45.41±10.20)mg/L] in the observation group were lower than those in the control group[(13.76±1.78)μg/L and (109.87±12.76)mg/L]( t=14.142, 11.320, 25.266, all P<0.05). The serum levels of BUN[(4.62±0.38)nmol/L] and Scr[(25.45±5.17)μmol/L] in the observation group were lower than those in the control group[(13.79±0.43)nmol/L and (68.79±4.15)μmol/L]( t=20.011, 18.421, all P<0.05). Conclusion:The effect of continuous renal replacement therapy on sepsis combined with acute renal injury is good, which can significantly reduce the inflammatory response of cells and improve the renal function of patients.