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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2023, Vol. 16 ›› Issue (05) : 376 -381. doi: 10.3877/cma.j.issn.1674-6880.2023.05.005

论著

碳酸氢钠林格液联合连续性肾脏替代疗法对创伤合并急性肾损伤患者炎症水平及肾功能的影响
韩圣瑾, 周正武†(), 翁云龙, 黄鑫   
  1. 237005　安徽六安，安徽医科大学附属六安医院急诊医学科
  • 收稿日期:2023-01-28 出版日期:2023-10-31
  • 通信作者: 周正武
  • 基金资助:
    中国初级卫生保健基金会临床科研专项资助项目(YLGX-JZ-2020011); 六安市人民医院2020年院级科研项目(2020kykt26)

Effect of sodium bicarbonate Ringer's solution combined with continuous renal replacement therapy on inflammation level and renal function in trauma patients with acute kidney injury

Shengjin Han, Zhengwu Zhou†(), Yunlong Weng, Xin Huang   

  1. Department of Emergency Medicine, Lu'an Hospital of Anhui Medical University, Lu'an 237005, China
  • Received:2023-01-28 Published:2023-10-31
  • Corresponding author: Zhengwu Zhou
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韩圣瑾, 周正武, 翁云龙, 黄鑫. 碳酸氢钠林格液联合连续性肾脏替代疗法对创伤合并急性肾损伤患者炎症水平及肾功能的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 376-381.

Shengjin Han, Zhengwu Zhou, Yunlong Weng, Xin Huang. Effect of sodium bicarbonate Ringer's solution combined with continuous renal replacement therapy on inflammation level and renal function in trauma patients with acute kidney injury[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(05): 376-381.

目的

探讨碳酸氢钠林格液（BRS）联合连续性肾脏替代疗法（CRRT）对创伤合并急性肾损伤（AKI）患者炎症水平及肾功能的影响。

方法

收集2020年4月至2022年4月收治的57例创伤合并AKI患者，分为观察组（29例）和对照组（28例）。观察组采用BRS联合CRRT治疗，对照组采用乳酸钠林格液联合CRRT治疗。比较两组患者治疗前后白细胞计数（WBC）、降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、肌酐、尿素氮、乳酸变化情况，并记录两组患者治愈情况。

结果

两组患者治疗前WBC（Z = 1.269，P = 0.204）、PCT（Z = 0.471，P = 0.638）、CRP（Z = 1.493，P = 0.135）、IL-6（t = 1.870，P = 0.067）、TNF-α（t = 0.961，P = 0.341）、肌酐（t = 1.701，P = 0.095）、尿素氮（t = 1.137，P = 0.260）、乳酸（t = 0.239，P = 0.812）水平比较，差异均无统计学意义。治疗后，观察组及对照组的WBC（Z = 4.703、3.196，P均< 0.001）、PCT（Z = 4.320、4.020，P均< 0.001）、CRP（Z = 4.620、4.540，P均< 0.001）、肌酐（t = 6.560、6.588，P均< 0.001）、尿素氮（t = 4.877、4.022，P均< 0.001）、乳酸（t = 5.852、6.073，P均< 0.001）水平均较治疗前显著下降，且观察组CRP水平较对照组下降更为明显（Z = 5.092，P < 0.001）；观察组IL-6（t = 4.619，P < 0.001）、TNF-α（t = 3.099，P = 0.004）水平较治疗前均显著下降，且观察组IL-6（t = 2.462，P = 0.017）、TNF-α（t = 2.404，P = 0.019）水平均明显低于对照组。同时，观察组的治愈占比显著高于对照组（27/29 vs. 20/28，χ2 = 4.884，P = 0.027）。

结论

采用BRS联合CRRT能够更有效地改善创伤合并AKI患者的肾功能，抑制炎症反应，提高患者的治愈情况。

关键词: 创伤, 急性肾损伤, 碳酸氢钠林格液, 连续性肾脏替代疗法, 炎症, 肾功能
Objective

To investigate the effect of sodium bicarbonate Ringer's solution (BRS) combined with continuous renal replacement therapy (CRRT) on the inflammation level and renal function in trauma patients with acute kidney injury (AKI).

Methods

A total of 57 trauma patients with AKI admitted from April 2020 to April 2022 were collected and divided into an observation group (29 cases) and a control group (28 cases). The observation group was treated with BRS combined with CRRT, and the control group was treated with the sodium lactated Ringer's solution combined with CRRT. The white blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), creatinine, urea nitrogen (BUN) and lactic acid before and after treatment were compared between the two groups, and the healing status of patients in the two groups was recorded.

Results

The WBC (Z = 1.269, P = 0.204), PCT (Z = 0.471, P = 0.638), CRP (Z = 1.493, P = 0.135), IL-6 (t = 1.870, P = 0.067), TNF-α (t = 0.961, P = 0.341), creatinine (t = 1.701, P = 0.095), BUN (t = 1.137, P = 0.260) and lactic acid (t = 0.239, P = 0.812) before treatment all showed no significant differences between the two groups. After treatment, the WBC (Z = 4.703, 3.196; both P < 0.001), PCT (Z = 4.320, 4.020; both P < 0.001), CRP (Z = 4.620, 4.540; both P < 0.001), creatinine (t = 6.560, 6.588; both P < 0.001), BUN (t = 4.877, 4.022; both P < 0.001) and lactic acid (t = 5.852, 6.073; both P < 0.001) in the observation group and control group were much lower than those before treatment, and the CRP level in the observation group was significantly lower than that in the control group (Z = 5.092, P < 0.001). The levels of IL-6 (t = 4.619, P < 0.001) and TNF-α (t = 3.099, P = 0.004) in the observation group after treatment were much lower than those before treatment, and the levels of IL-6 (t = 2.462, P = 0.017) and TNF-α (t = 2.404, P = 0.019) in the observation group also decreased markedly as compared with the control group. Meanwhile, the proportion of cure in the observation group was much higher than that in the control group (27/29 vs. 20/28, χ2 = 4.884, P = 0.027).

Conclusion

BRS combined with CRRT can effectively improve the renal function, inhibit the inflammatory response and improve the cure status of trauma patients with AKI.

Key words: Trauma, Acute kidney injury, Sodium bicarbonate Ringer's solution, Continuous renal replacement therapy, Inflammation, Renal function
表1 两组创伤合并AKI患者一般资料的比较（ ± s）
组别 例数 年龄（岁） 男/女（例） 住院费用（万元） ISS（分） ICU住院天数（d） 致伤原因（例）
交通事故 高空坠落 其他
观察组 29 39 ± 13 19/10 5.2 ± 1.8 25 ± 7 8.8 ± 1.7 20 7 2
对照组 28 36 ± 11 16/12 5.4 ± 1.8 24 ± 6 11.2 ± 2.8 19 6 3
t/χ2值   1.299 0.422 0.506 0.519 3.875 0.286
P值   0.199 0.516 0.615 0.606 <0.001 0.867
表2 两组创伤合并AKI患者治疗前后感染指标的比较[M（P25，P75）]
组别 例数 WBC（× 109/L） PCT（μg/L） CRP（mg/L）
观察组        
治疗前 29 11（8，14） 16（7，29） 50（24，82）
治疗后 29 6（5，8）a 10（4，16）a 15（12，23）a
对照组        
治疗前 28 14（9，15） 15（10，29） 68（38，85）
治疗后 28 7（6，8）a 10（5，21）a 41（29，56）ab
图1 两组创伤合并AKI患者炎症介质IL-6和TNF-α水平在治疗前后的比较注：AKI.急性肾损伤；IL-6.白细胞介素6；TNF-α.肿瘤坏死因子α；与同组治疗前比较，aP < 0.05；与观察组同时间点比较，bP < 0.05
图2 两组创伤合并AKI患者肾功能指标肌酐和尿素氮水平在治疗前后的比较注：AKI.急性肾损伤；与同组治疗前比较，aP < 0.05
图3 两组创伤合并AKI患者乳酸水平在治疗前后的比较注：AKI.急性肾损伤；与同组治疗前比较，aP < 0.05
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