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目的分析连续性肾脏替代疗法对ICU危重脓毒症患者免疫功能及预后的影响。方法选择2012年2月—2015年2月收治的70例ICU危重脓毒症患者作为研究对象,随机分为对照组和实验组各35例。对照组采取常规治疗,实验组在对照组基础上加以连续性肾脏替代治疗。比较两组临床疗效、治疗前后炎性因子及免疫细胞功能指标变化情况。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果实验组临床治愈率为68.6%,显著高于对照组的42.9%,差异有统计学意义(P<0.05)。实验组与对照组治疗后IL-1、IL-6、CRP水平分别为(22.2±3.8)、(60.0±18.6)ng/L、(21.5±7.5)mg/L、(40.0±10.4)、(111.3±18.0)ng/L、(31.2±6.3)mg/L,均明显低于治疗前的(111.8±21.9)、(198.2±15.7)ng/L、(68.2±14.5)mg/L,(110.7±19.6)、(197.9±17.4)ng/L、(66.9±14.8)mg/L,差异均有统计学意义(均P<0.05)。实验组与对照组治疗后CD3+、CD4+、CD4+/CD8+水平分别为(68.6±7.5)%、(40.4±7.7)%、(1.61±0.30)、(48.5±8.7)%、(34.8±7.5)%、(1.20±0.33),均明显高于治疗前的(41.4±8.3)%、(20.8±5.9)%、(1.07±0.11)、(41.0±7.4)%、(21.3±5.4)%、(1.07±0.13),差异均有统计学意义(均P<0.05)。两组治疗后IL-1、IL-6、CRP、CD3+、CD4+、CD4+/CD8+水平比较差异均有统计学意义(均P<0.05)。结论连续性肾脏替代治疗ICU危重脓毒症临床治愈率高,能明显减轻炎性反应,改善机体细胞免疫功能。
Objective To analyze the effect of continuous renal replacement therapy on immune function and prognosis in patients with severe sepsis in ICU. Methods Seventy ICU patients with severe sepsis admitted from February 2012 to February 2015 were randomly divided into control group and experimental group of 35 cases each. The control group to take conventional treatment, the experimental group in the control group to be based on continuous renal replacement therapy. The clinical curative effect, the inflammatory factors before and after treatment and the changes of immune cell function indexes were compared. Measurement data were compared between groups using t test, the group was compared using paired t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The clinical cure rate was 68.6% in the experimental group, which was significantly higher than that in the control group (42.9%, P <0.05). The levels of IL-1, IL-6 and CRP in experimental group and control group were (22.2 ± 3.8), (60.0 ± 18.6) ng / L, (21.5 ± 7.5) mg / L and (111.3 ± 18.0) ng / L and (31.2 ± 6.3) mg / L respectively, which were significantly lower than those before treatment (111.8 ± 21.9), (198.2 ± 15.7) ng / L and ± 19.6), (197.9 ± 17.4) ng / L and (66.9 ± 14.8) mg / L, respectively (all P <0.05). The levels of CD3 +, CD4 + and CD4 + / CD8 + in the experimental and control groups were (68.6 ± 7.5)%, (40.4 ± 7.7)%, (1.61 ± 0.30), (48.5 ± 8.7)% and (34.8 ± 7.5)% , (1.20 ± 0.33), (41.4 ± 8.3)%, (20.8 ± 5.9)%, (1.07 ± 0.11), (41.0 ± 7.4)%, (21.3 ± 5.4)% and ± 0.13), the differences were statistically significant (all P <0.05). The levels of IL-1, IL-6, CRP, CD3 +, CD4 +, CD4 + / CD8 + in the two groups after treatment were significantly different (all P <0.05). Conclusion Continuous renal replacement therapy for ICU critically ill sepsis clinical cure rate can significantly reduce the inflammatory response and improve the body's cellular immune function.