连续性肾脏替代治疗在腹腔内感染引起的脓毒症治疗中的研究进展
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摘要
腹腔内感染是外科常见、多发的病程之一,其引起的脓毒症在临床上治疗难度大、死亡率高,是ICU的急危重症。脓毒症的病理生理机制复杂,涉及失控性的炎症反应、凝血功能障碍、免疫功能失调等多个方面,进而损伤各脏器及细胞组织,诱发脏器衰竭。连续性肾脏替代疗法在脓毒症的治疗中起着不可替代的作用,但其在腹腔内感染引起的脓毒症中的应用仍处于起步阶段。因此,连续性肾脏替代治疗在腹腔内感染引起的脓毒症中的应用还有待进一步探索。
Abdominal infection is one of the common infection symptoms in the perioperative period, and the sepsis caused by it is the key to death. The occurrence of sepsis is mainly caused by the release of inflammatory mediators in the body after infection, leading to coagulation dysfunction, which causes the body's inflammatory immune system to be dysfunctional, thereby damaging various organs and cell tissues, and inducing organ failure. Continuous renal replacement therapy plays an irreplaceable role in the treatment of sepsis,but its application in abdominal infection is still in its infancy. Therefore, the application of continuous renal replacement therapy in sepsis caused by abdominal infection remains to be further explored.
Abdominal infection is one of the common infection symptoms in the perioperative period, and the sepsis caused by it is the key to death. The occurrence of sepsis is mainly caused by the release of inflammatory mediators in the body after infection, leading to coagulation dysfunction, which causes the body's inflammatory immune system to be dysfunctional, thereby damaging various organs and cell tissues, and inducing organ failure. Continuous renal replacement therapy plays an irreplaceable role in the treatment of sepsis,but its application in abdominal infection is still in its infancy. Therefore, the application of continuous renal replacement therapy in sepsis caused by abdominal infection remains to be further explored.
引文
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[24]李少华,郑晨,尹大乐,等.不同时机连续性肾脏替代治疗对脓毒症患者的影响[J].中国医药科学,2017,7(23):240-243.
[25]李旭,阿丽娅,刘加明,等.脓毒症合并急性肾损伤3期患者启动肾脏替代治疗时机的研究[J].中国血液净化,2018,17(10):652-657.
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[27]张颖萍,秦龙,刘秋旻,等.局部枸橼酸抗凝与全身肝素抗凝治疗脓毒症急性肾损伤的效果对比[J].实用老年医学,2017,31(4):470-476.
[28]杨晓波,王金柱,刘明晨,等.枸橼酸钠在脓毒症伴高危出血因素患者行连续性肾脏替代治疗中的应用效果分析[J].护理与康复,2018,17(9):10-14.
[2]Claudio Ronco,张凌,陆任华,等.重症肾脏替代治疗和血液净化技术的标准化术语命名[J].华西医学,2018,33(7):782-796.
[3]刘大为,杨荣利,陈秀凯.重症血液净化[M].北京:人民卫生出版社,2017:495-498.
[4]陈鹏,李盖天,熊诗萌,等.腹腔内感染及其相关治疗的研究[J].华南国防医学杂志,2018,32(3):210-213.
[5]林志亮,李宁.腹腔开放技术的研究进展[J].医学研究生学报,2013,26(11):1219-1222.
[6]MAZUSKI JE,TESSIER JM,MAY AK,et al.The surgical infection society revised guidelines on the management of intra-abdominal infection[J].Surg In fect(Larchmt),2017,18(1):1-76.
[7]李振东.37例原发性腹膜炎患者的临床分析[J].世界最新医学信息文摘,2016,16(31):73.
[8]Sheng WH,Badal RE,Hsueh PR,et al.Distribution of extended spectrumβ-lactamases,AmpCβ-lactamases,and carbapenemases among Enterobacteriaceae isolates causing intra-abdominal infec-tions in the AsiaPacific region:results of the study for Monitoring Antimicrobial Resistance Trends(SMART)[J].Antimicrob A-gents Chemother,2013,57(7):2981-2988.
[9]Rhodes A,Evans LE,Alhazzani W,et al.Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J].Crit Care Med,2017,45(3):486-552.
[10]Loonen AJ,de Jager CP,Toserams J,et al.Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit[J].PLoS One,2014,9(1):e87315.
[11]Hatori T,Nishiyama H,Kato H,et al.Clinical value of procalcitonin for patients with suspected bloodstream infection[J].Am J Clin Pathol,2014,141(1):43-51.
[12]许涛,盛晓华,崔勇平,等.CRRT在脓毒血症急性肾损伤患者救治中的临床研究[J].中国血液净化,2013,12(12):646-650.
[13]刘晗,秦秉玉,邵换璋,等.持续肾脏替代治疗对严重脓毒症患者血清中高迁移率族蛋白-1、白介素-8和-12水平的影响[J].中国老年学杂志,2012,32(16):3442-3443.
[14]Mehta RL.Challenges and pitfalls when implementing renal replacement therapy in the ICU[J/OL].Crit Care,2015,19(Suppl 3):S9.
[15]余凯,蒋龙元,温立强.CRRT在脓毒症/MODS中的应用[J].中国社区医师,2018,34(36):6-7.
[16]刘金涛,罗海丽,袁通梅,等.连续性肾脏替代治疗对老年脓毒症患者肠功能、免疫功能和预后转归的影响[J].山东医药,2017,57(10):92-94.
[17]Clark E,Molnar AO,Joannes-Boyau O,et al.High-volume hemofiltration for septic acute kidney injury:a systematic review and meta-analysis[J].Crit Care,2014,18(1):R7.
[18]Brendolan A,D’Intini V,Ricci Z,et al.Pulse high volume hemofiltration[J].Int J Artif Organs,2004,27(5):398-403.
[19]Ghani RA,Zainudin S,Ctkong N,et al.Serum IL-6 and IL-1-ra with sequential organ failure assessment scores in septic patients receiving highvolume haemofiltration and continuous venovenous haemofiltration[J].Nephrology(Carlton),2006,11(5)386-393.
[20]Joannes-Boyau O,HonoréPM,Perez P,et al.High-volume versus standardvolume haemofiltration for septic shock patients with acute kidney injury(IVOIRE study):a multicentre randomized controlled trial[J].Intensive care medicine,2013,39(9):1535-1546.
[21]王大为,付研.连续性肾脏替代治疗[J].中国临床医生,2014,42(7):86-88.
[22]赵荣,王欢欢,谢秀华.不同连续性肾脏替代治疗模式对脓毒症休克合并多器官功能损害患者预后的影响分析[J].中国医学前沿杂志,2018,10(11):82-85.
[23]徐小姗,黄智敏,陈晶.不同时机连续性肾脏替代治疗(CRRT)对脓毒症患者疗效探析[J].中国医疗器械信息,2018,24(08):116-117.
[24]李少华,郑晨,尹大乐,等.不同时机连续性肾脏替代治疗对脓毒症患者的影响[J].中国医药科学,2017,7(23):240-243.
[25]李旭,阿丽娅,刘加明,等.脓毒症合并急性肾损伤3期患者启动肾脏替代治疗时机的研究[J].中国血液净化,2018,17(10):652-657.
[26]陈洁,陈俊峰,邵汉权.脓毒症患者CRRT治疗中不同抗凝方案疗效对比[J].现代诊断与治疗,2017,28(10):1894-1896.
[27]张颖萍,秦龙,刘秋旻,等.局部枸橼酸抗凝与全身肝素抗凝治疗脓毒症急性肾损伤的效果对比[J].实用老年医学,2017,31(4):470-476.
[28]杨晓波,王金柱,刘明晨,等.枸橼酸钠在脓毒症伴高危出血因素患者行连续性肾脏替代治疗中的应用效果分析[J].护理与康复,2018,17(9):10-14.