Clinical Efficacy of Continuous Renal Replacement Therapy in Severe Burn Sepsis
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摘要:
目的 探讨连续性肾脏替代治疗对重度烧伤脓毒症患者的临床疗效。 方法 回顾性分析昆明医科大学第二附属医院烧伤科在2020年1月至2023年1月收治且符合入选标准的因重度烧伤导致脓毒症的40名患者。按照治疗方式区分为对照组和治疗组，每组20例。对照组进行常规的对症支持治疗，治疗组在常规治疗的基础上，继续给予连续性肾脏替代治疗，对照组和治疗组都抽取治疗前和治疗后 24、48、7 h的静脉血进行化验，进一步比较2组患者C反应蛋白（CRP），白介素-6（IL-6），白细胞（WBC）、降钙素原（PCT）、血清肌酐（Scr）、血尿素氮（BUN）水平;比较2组患者的住院时间及总住院费用。 结果 治疗前2组C反应蛋白（CRP），白介素-6（IL-6），白细胞（WBC）、降钙素原（PCT）、血清肌酐（Scr）、血尿素氮（BUN）水平相比差异无统计学意义（P > 0.05）；治疗72 h后观察C反应蛋白（CRP）、白介素-6（IL-6）、白细胞（WBC）、降钙素原（PCT）、血清肌酐（Scr）、血尿素氮（BUN）水平，结果发现，实验组数值均低于对照组数值，差异有统计学意义（P < 0.05）。此外，持续性肾脏替代治疗组的住院时间和总住院费用较常规治疗组低（P < 0.05）。 结论 在重度烧伤脓毒症患者中，持续性肾脏替代治疗效果显著，能有效清除炎性介质，防治失控性炎性反应， 对烧伤创面脓毒血症等全身性感染所带来的症状能起到有效的缓解作用，防治应激损伤和脓毒症引起的脏器损伤，在临床上表现出良好的应用前景，同时也能带来一定的经济效益和社会效益。 Abstract:Objective To investigate the clinical efficacy of continuous renal replacement therapy（CRRT） in patients with severe burn sepsis. Methods Forty patients with sepsis caused by severe burns who met the inclusion criteria and were admitted to the Department of Burns of the Second Affiliated Hospital of Kunming Medical University from January 2020 to January 2023 were retrospectively analyzed. According to the treatment, patients were divided into control group and treatment group, with 20 patients in each group. The control group was given conventional symptomatic and supportive treatment, and the treatment group was given continuous renal replacement therapy on the basis of conventional treatment. The venous blood of the control group and the treatment group was taken before treatment and 24, 48, 72 hours after treatment. White blood cells（WBC）, calcitonin（PCT）, serum creatinine（Scr）, blood urea nitrogen（BUN） level. In addition, the length of hospital stay and the total cost of hospitalization were compared between the two groups. Results Before treatment, the levels of C-reactive protein（CRP）, interleukin-6（IL-6）, white blood cell（WBC）, procalcitonin（PCT）, serum creatinine（Scr） and blood urea nitrogen（BUN） in the two groups were compared, the P value was above 0.05, and the difference was not significant in the statistical data. 72 hours after treatment group C reactive protein（CRP） and interleukin 6（IL - 6）, white blood cell（WBC）, calcitonin（PCT）, serum creatinine（Scr）, blood urea nitrogen（BUN） level, the results show that numerical value was lower than the control group, experimental group and the difference between the P value is less than 0.05, has significant statistical significance. In addition, the length of hospital stay and total hospital costs were also statistically lower in the CRRT group than in the usual care group. Conclusion In severe burn patients with sepsis, continuous renal replacement therapy has a significant effect, which can effectively remove inflammatory mediators, prevent and treat uncontrolled inflammatory response, and effectively relieve the symptoms caused by systemic infections such as burn wound sepsis. It has a good application prospect in the prevention and treatment of stress injury and organ injury caused by sepsis in clinical practice. At the same time, it can also bring certain economic and social benefits. -
表 1 2组白细胞（WBC）对比[M（P25，P75），109/L]
Table 1. Comparison of white blood cells （WBC） between the two groups [M（P25，P75），109/L]
分组 治疗前 治疗后24 h 治疗后48 h 治疗后72 h M P 常规治疗组 20.2（15.14 ，24.5） 10.57（5.2 ，12.54） 11.12（4.99 ，14.82） 6.45（3.37 ，8.02） 48.480 < 0.001* CRRT治疗组 17.4（11.88 ，28.29） 4.95（4.07 ，8.15）△ 5.28（4.33 ，8）△ 2.84（2.48 ，5.33）△ 54.540 < 0.001* z 0.054 2.218 2.083 2.002 - - P 0.957 0.027* 0.037* 0.045* - - P < 0.05；与治疗前比较，△P < 0.05。 
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表 2 2组白介素-6（IL-6）对比[M（P25，P75），pg/mL]
Table 2. two groups of interleukin 6 （IL - 6） contrast [M（P25，P75），pg/mL]
分组 治疗前 治疗后24 h 治疗后48 h 治疗后72 h M P 常规
治疗组263.71（162.89 ，361.84） 186.01（107.18 ，280.56） 186.55（107.68 ，289.37） 137.74（68.76 ，196.66）△ 39.660 < 0.001* CRRT
治疗组228.23（192.4 ，476.6） 119.7（45.15 ，169.47）△ 114.61（41.96 ，177）△ 75.28（32.33 ，97.63）△ 51.120 < 0.001* z 0.568 2.056 2.056 2.164 - - P 0.570 0.040* 0.040* 0.030* - - P < 0.05；与治疗前比较，△P < 0.05。
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表 3 2组降钙素原（PCT）对比[M（P25，P75），ng/mL]
Table 3. Comparison of procalcitonin （PCT） between the two groups [M（P25，P75），ng/mL]
分组 治疗前 治疗后24 h 治疗后48 h 治疗后72 h M P 常规治疗组 4.48（4.08 ，5.85） 3.53（2.97 ，5.16） 3.65（2.99 ，5.53） 2.11（1.86 ，3.54）△ 37.620 < 0.001* CRRT治疗组 4.2（2.43 ，11.83） 1.89（1.23 ，4.9）△ 2.07（1.4 ，5.81） 1.17（0.82 ，3.24）△ 38.640 < 0.001* z 1.001 2.272 2.313 2.137 - - P 0.317* 0.023* 0.021* 0.033* - - P < 0.05；与治疗前比较，△P < 0.05。
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表 4 2组肌酐（Scr）对比[M（P25，P75），μmol/L]
Table 4. Comparison of creatinine （Scr） between the two groups [M（P25，P75），μmol/L]
分组 治疗前 治疗后24 h 治疗后48 h 治疗后72 h M P 常规治疗组 113.5（104.73 ，132.75） 97（88.25 ，108.25）△ 97.5（89 ，114.25） 62.5（56.75 ，81）△ 46.598 < 0.001* CRRT治疗组 133（90.5 ，191.5） 64（20.75 ，107）△ 66（22 ，98）△ 44（13.75 ，70.5）△ 45.879 < 0.001* z 0.825 2.097 2.625 2.016 - - P 0.409 0.036* 0.009* 0.044* - - P < 0.05；与治疗前比较，△P < 0.05。
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表 5 2组尿素（BUN）对比[M（P25，P75），mmol/L]
Table 5. Comparison of urea （BUN） between the two groups [M（P25，P75），mmol/L]
分组 治疗前 治疗后24 h 治疗后48 h 治疗后72 h M P 常规治疗组 12.1（10.89 ，13.65） 8.29（7.47 ，9.31）△ 7.87（7.12 ，9.9）△ 5.7（4.99 ，6.33）△ 52.260 < 0.001* CRRT治疗组 12.3（9.72 ，15.39） 4.81（2.58 ，9.21） 3.39（1.56 ，8.52）△ 3.91（1.81 ，5.81）△ 42.720 < 0.001* z 0.027 2.083 2.786 2.245 - - P 0.978 0.037* 0.005* 0.025* - - P < 0.05；与治疗前比较，△P < 0.05。
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表 6 2组超敏C反应蛋白（CPR）对比[M（P25，P75），mg/mL]
Table 6. Comparison of high-sensitivity C-reactive protein （CPR） between the two groups [M（P25，P75），mg/mL]
分组 治疗前 治疗后24 h 治疗后48 h 治疗后72 h M P 常规治疗组 59.38（51.17 ，101.8） 85.53（41.69 ，144.05） 94.44（38.72 ，157.22） 67.86（30.69 ，98.8）△ 25.380 < 0.001* CRRT治疗组 84.65（37.52 ，135.51） 56.87（18.34 ，66.41） 56.36（18.69 ，74.62） 36.51（10.61 ，45.65）△ 29.520 < 0.001* z 0.081 2.083 2.272 2.164 - - P 0.935 0.037* 0.023* 0.030* - - P < 0.05；与治疗前比较，△P < 0.05。
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表 7 2组住院时间（d）和总住院费用（万元）对比（Mean ± SD）
Table 7. Comparison of length of stay （days） and total hospitalization cost （ten thousand yuan） between the two groups（Mean ± SD）
分组 住院时间（d） 住院总费用（万元） 常规治疗组 40.75 ± 5.98 41.63 ± 4.02 CRRT治疗组 37.05 ± 5.20 38.68 ± 4.75 t 2.088 2.121 P 0.044* 0.041* 与常规治疗组比较，*P < 0.05。
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