血浆透析滤过治疗脓毒症急性肾损伤的临床研究  

A clinical study on plasma diafiltration for the treatment of septic acute kidney injury

作　　者：顾燕红[1,2] 李铭新[1] 王洪娜[1] 刘骏峰[1] 张蕾[1] 游怀舟[1] 薛骏[1] 顾勇[1] 郝传明[1] 林善锬[1] 

机构地区：[1]复旦大学附属华山医院肾脏科,上海进修生200040 [2]上海市浦东医院肾脏科,上海200040

出　　处：《中国血液净化》2013年第12期680-685,共6页Chinese Journal of Blood Purification

基　　金：国家自然科学基金(项目编号:81271731)

摘　　要：目的探讨血浆透析滤过(Plasmadiafiltration,PDF)治疗脓毒症性急性肾损伤患者的有效性和安全性。方法入选12名诊断为脓毒症性急性肾损伤的患者,按照随机区组的方法将患者分为血浆透析滤过组和连续静脉-静脉血液滤过(Continues venous-venous Hemofiltration,CVVH)组,比较2组患者的基线特征,不同血液净化方法治疗后,比较2组之间在器官功能改善、整体病情评估、生存率、肾存活以及血液净化的充分性和安全性方面的差异,进行统计分析。结果 2组分别入选6名患者,2组患者在进行血液净化治疗前的基线特征无明显差异,经过不同净化方式治疗后,PDF组较CVVH组能明显降低APACHEⅡ评分(P=0.032)、降低校正的死亡危险度(P=0.015)以及明显改善肾脏的存活(P=0.0203)。PDF组在改善循环功能、肾功能和肺功能方面优于CVVH组,但无统计学差异。不同的血液净化方式在生存率以及血液净化的充分性和安全性方面无显著差异。结论 PDF在改善脓毒症性肾损伤患者的器官功能方面具有一定的优越性。Objective To investigate the effectiveness and safety of plasma diafiltration （PDF） in the treatment of septic acute kidney injury.Method Twelve patients with septic acute kidney injury were enrolled in this study.They were divided based on randomized blocks into PDF group or continuous veno-venous hemofiltration （CVVH） group.Baseline characteristics,organ functions,overall conditions,survival,kidney survival as well as sufficiency and safety of PDF were statistically analyzed.Result Six patients were included in each group,and there were no significant differences in baseline characteristics between the two groups.After treatment,APACHE Ⅱ score （P=0.032） and corrected mortality risk （P=0.015） reduced significantly and the kidney survival improved significantly （P=0.0203） in PDF group,as compared with those in CVVH group.PDF was better than CVVH in improving circulation,kidney and lung functions but without statistical significances （P〉0.05） between the two groups.Survival rate,blood purification sufficiency,and safety were similar between the two blood purification methods.Conclusion PDF had the advantages of improving organ functions in patients with septic acute kidney injury.

关 键 词：血浆透析滤过 脓毒症 截留分子质量 

分 类 号：R459.5[医药卫生—治疗学]