中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (09): 604-607.doi: 10.3969/j.issn.1671-4091.2018.09.006

• 临床研究 • 上一篇    下一篇

连续性血液净化及其感染管理对艾滋病相关SIRS 合并急性肾衰竭患者血浆炎性介质、电解质的影响

兰玲鲜1,苏春雄1,黄瑞芬1,陈秋霞1,郑卉1,陆新春1   

  1. 1. 广西医科大学附属南宁市传染病医院血液净化科广西艾滋病临床治疗中心南宁市第四人民医院血液净化科
  • 收稿日期:2017-07-03 修回日期:2018-06-26 出版日期:2018-09-12 发布日期:2018-08-24
  • 通讯作者: 苏春雄 suchunxiong123@163.com E-mail:suchunxiong123@163.com
  • 基金资助:

    南宁市科学研究与技术开发计划项目(20163013)；广西壮族自治区卫生厅自筹项目经费科研课题(z2014476)

Effects of continuous blood purification and infection management on plasma inflammatory mediators and electrolytes in AIDS related systemic inflammatory response syndrome (SIRS) patients complicated with acute renal failure

  • Received:2017-07-03 Revised:2018-06-26 Online:2018-09-12 Published:2018-08-24

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摘要： 【摘要】目的探究连续性血液净化及其感染管理对艾滋病相关全身炎症反应综合征(systemic inflammatory response syndrome，SIRS)合并急性肾衰患者血浆炎性介质、电解质的影响。方法选取2012 年1 月～2015 年12 月广西医科大学附属南宁市传染病医院收治的艾滋病相关SIRS 合并急性肾衰竭并行连续血液净化的30 例患者作为研究对象，在患者入院后对其进行持续监测，并行规范化感染管理，对30 例患者均经右颈内静脉行连续性血液净化治疗，治疗后根据院内感染诊断标准判断感染管理效果，并通过对比治疗前后相关血清炎症因子水平确定治疗效果。结果行连续性血液净化治疗后2h 及6h肿瘤坏死因子-a(tumor necrosis factor-a,TNF-a)明显低于治疗前，与治疗前有明显差异(t=32.134、29.013，P=0.011、0.016)；连续性血液净化治疗后2h 及6h 白介素-6(interleukin-6,IL-6)明显低于治疗前，与治疗前有明显差异(t=28.003、30.012，P=0.018、0.013)；连续性血液净化治疗后2h 及6h IL-10 分明显低于治疗前，与治疗前有明显差异(t=35.412、34.054, P=0.009、0.010)。且3 项指标连续血液净化治疗时间越长炎症因子水平越低。治疗前血尿素氮(blood urea nitrogen, BUN)、钾(kalium, K)、钠(natrium，Na)、氯(chlorine, Cl)及血糖(glucose, Glu)均明显高于治疗2h 后的水平 ( t =15.412、18.013、19.223、18.107、20.224，P=0.042、0.031、0.021、0.029、0.001)，且上述指标的治疗前水平高于治疗后6h的水平(t=20.223、24.0014、22.012、25.321、19.031，t=0.042、0.028、0.038、0.022、0.045)，治疗后2h BUN、K 高于治疗后6h(t=2.948、2.746，P=0.005、0.008)。30 例患者接受连续性血液净化处理后，存活19 例，死亡11 例，存活率为63.3%。结论对艾滋病相关SIRS 合并急性肾衰竭患者通过规范化的院内感染管理能明显减少院内的感染发生率，并且通过连续血液净化能明显减少患者的血浆炎性介质因子水平、纠正酸碱平衡及稳定内环境，利于肾衰竭患者的恢复。

关键词: 全身炎症反应综合征, 肾衰竭, 连续性血液净化, 感染, 炎性介质

Abstract: 【Abstract】Objective To analyze the effects of continuous blood purification (CBP) and infection management on plasma inflammatory mediators and electrolytes in AIDS patients complicated with systemic inflammatory response syndrome (SIRS) and acute renal failure. Methods A total of 30 AIDS patients complicated with SIRS and acute renal failure treated in our hospital from January 2012 to December 2015 were enrolled in this study. After admission they were closely monitored and treated with the routine management. They were treated with CBP through right jugular vein. The effects of infection management were determined according to the diagnostic criteria for hospital infection, and their therapeutic effects were estimated by comparison of plasma inflammatory mediators before and after the therapy. Results After CBP for 2 hours and 6 hours, plasma TNF-α, IL-6 and IL-10 decreased significantly (P<0.05, for TNF-α, IL-6 and IL-10 at 2 hours and 6 hours); plasma TNF-α, IL-6 and IL-10 decreased further along with the CBP duration. Plasma BUN, K, Na, Cl and glucose decreased after CBP for 2 hours and 6 hours (P＜0.05, for BUN, K, Na, Cl and glucose at 2 hours and 6 hours). Plasma BUN and K after CBP for 6 hours were lower than those after CBP for 2 hours (P＜0.05). In the 30 patients treated with CBP, 11 patients died and 19 patients survived with the survival rate of 63.3%. Conclusion For AIDS patients complicated with SIRS and acute renal failure, nosocomial infections could be reduced significantly through standardized management of nosocomial infections, and their abnormal levels of plasma inflammatory mediators, imbalance of electrolytes, derangement of homeostasis and renal failure could be improved by CBP.

Key words: systemic inflammatory response syndrome, renal failure, continuous blood purification, infection, inflammatory mediators