Effects Of Different Doses Of Once Daytime Crrt On Immune Function Of Patients With Severe Pneumonia And Acute Kidney Injury

Objective to observe the effects of different doses of once daytime Continuous Renal Replacement Therapy (CRRT) on immune function of patients with severe pneumonia and acute kidney injury(AKI).Method A total of 30 patients diagnosed with severe pneumonia and AKI were selected in this study, who stayed in our intensive care unit in the period of August 2010 to January 2011. They were randomly divided into three groups and received different doses of daytime Continuous Renal Replacement Therapy for 12 hours .The first group who were treated by daytime CRRT with the ultrafiltration rate at 100 ml/(kg·h)were considered as the high-dose group, the second group who were treated by daytime CRRT with the ultrafiltration rate at 65 ml/(kg·h) were considered as the middle-dose group,and the last group who were treated by daytime CRRT with the ultrafiltration rate at 35 ml/(kg·h) were considered as the low-dose group. Heart rate(HR),mean arterial pressure(MAP),serum creatinine(sCr),C reactive protein(CRP),lymphocyte CD4+/CD8+,the phagocytosis rates and phagocytosis indexes of polymorphonuclear neutrophil(PMN),APACHE(acute physiology and chronic health evaluation )Ⅱwere detected before and after CRRT.Observed their 72h survival rates.Results In all patients, the changes of MAP were not statistically significan(tP>0.05).Compared with pre-treatment, HR (P﹤0.05)and sCr (P﹤0.05)were decreased after the treatment,but the differences among 3 dose groups were not statistically significant(P>0.05). Serum levels of CRP were also decreased after the treatment(P﹤0.05), and the level in high-dose group decreased most rapidly in 3 groups(P﹤0.05), the changes did not differ between middle-dose group and low-dose group(P>0.05).Lymphocyte CD4+/CD8+ was increased after the treatment(P﹤0.05),but the differences among 3 dose groups were not statistically significant ( P>0.05 ) .The phagocytosis rates(P﹤0.05) and phagocytosis indexes(P﹤0.05)of PMN were increased, the level in high-dose group increased most rapidly among 3 groups(P﹤0.05),and the level in middle-dose group increased more rapidly than that in low-dose group(P﹤0.05).Scores of APACHEⅡwere decreased after the treatment, the scores in high-dose group decreased most rapidly among 3 groups(P﹤0.05),and the scores in middle-dose group decreased more rapidly than that in low-dose group(P﹤0.05). 72h survival rate of the high-dose group was 90%,that of the middle-dose group was 100%,and the low-dose group was also 100%. They were not statistically significant(P>0.05).Conclusion Once daytime CRRT has satisfactory hemodynamics. It could decrease the levels of lserum creatinine and CRP, increase lymphocyte CD4~+/CD8~+,strengthen the phagocytosis function of PMN,enhance immune function and decrease the scores of APACHEⅡin patients with severe pneumonia and AKI,and the effects in high-dose group were better than those in middle- and low-dose group.