持续低效血液透析联合血液灌流与连续性血液净化治疗脓毒症急性肾损伤的疗效对比  

Comparison of the therapeutic effect between sustained low - efficiency dialysis combined hemoperfusion and continuous blood purification in patients with septic acute kidney injury

作　　者：盂晓燕 黄向阳[1] 谭鹤长[1] 刘倩[1] 王英[1] 

机构地区：[1]广西医科大学第四附属医院肾内科,广西柳州545005

出　　处：《中国急救医学》2014年第12期1061-1064,I0009,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的比较持续低效血液透析（sustained low—efficiency dialysis，SLED）联合血液灌流（hemoperfusion，HP）与连续性血液净化（continuous blood purification，CBP）在脓毒症急性肾损伤（AKI）患者中的治疗效果。方法52例脓毒症AKI患者，根据行血液净化方式不同分为SLED联合HP组（n=25）及CBP组（n=27），比较两组治疗前后平均动脉压（MAP）、氧合指数（PaO2／FiO2，OI）、血肌酐（Scr）、肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）及急性生理学与慢性健康状况评分系统Ⅱ（acute physiology and chronic health evaluation，APACHEⅡ）评分、ICU住院时间及90d死亡率等指标。结果两组治疗后第1、2、3、7天Scr、TNF—α、IL-6水平较治疗前均明显下降（P〈0．05），第2、3、7天APACHEⅡ评分较治疗前明显下降（P〈0．05），OI、MAP明显上升（P〈0．05）。SLED联合HP组在治疗后第2、3、7天的Scr、TNF-α、IL-6、APACHEⅡ评分均低于CBP组，0I及MAP均高于CBP组（P〈0．05），ICU住院时间短于CBP组，但两组90d死亡率差异无统计学意义（P〉0．05）。结论SLED联合HP治疗脓毒症AKI在毒素及炎症介质清除方面优于CBP组，能缩短ICU住院时间，但90d死亡率与CBP组比较差异无统计学意义，提示临床预后方面SLED联合HP治疗可能并不优于CBP组。Objective To compare the therapeutic effect between sustained low- efficiency dialysis （SLED） combined hemoperfusion （HP） and continuous blood purification （CBP） in patients with septic acute kidney injury （AKI）. Methods Fifty - two patients during January 2010 and January 2013 with septic AKI were randomly assigned to receive SLED combined HP group （ n = 25 ） and CBP group （n = 27 ） according to the different treatment ways. The mean arterial pressure （MAP）, oxygenation index （ OI）, serum creatinine （ Scr）, tumor necrosis factor - α（ TNF - α）, interleukin - 6 （IL-6） and acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score, ICU stay, 90 - day mortality were compared before and after treatment of two groups. Results The levels of Scr, TNF-α, IL- 6, APACHE Ⅱ score after treatment of 2, 3, 7 -day decreased significantly in SLED combined HP group compared with CBP group （ P 〈 0.05 ）, but OI and MAP increased significantly （ P 〈 0.05）. There were significant differences in ICU stay between two groups （P 〈 0.05 ） , but there were no significant differences in 90 - day mortality between two groups （ P 〉 0.05 ）. Conclusion SLED combined HP treatment may be superior to CBP treatment in clearing toxins and inflammatory mediators, and can shorten the ICU stay, but may not be superior to CBP in improving clinical outcomes.

关 键 词：持续低效透析 连续性血液净化 血液灌流 炎症介质 脓毒症 急性肾损伤 

分 类 号：R59[医药卫生—内科学]