血液净化方式和时机对防治脓毒症致急性肾损伤临床效果的影响  

The Effect of Method and Timing of Blood Purification on the Therapeutic Effect of Acute Kidney Injury Caused by Sepsis

作　　者：张任[1] 李正东[1] 曾艳[1] 

机构地区：[1]湖北医药学院附属东风医院肾病内科,湖北十堰442000

出　　处：《医学综述》2016年第2期374-376,共3页Medical Recapitulate

摘　　要：目的研究不同血液净化方式和时机对脓毒症致急性肾损伤的防治效果。方法回顾性分析2012年2月至2014年6月湖北医药学院附属东风医院收治的103例脓毒症患者的临床资料,按血液净化方式不同分为连续性肾脏替代疗法(CRRT)组52例,间歇性血液透析(IHD)组51例。其中CRRT组Ⅰ期15例,Ⅱ期20例,Ⅲ期17例;IHD组Ⅰ期15例,Ⅱ期20例,Ⅲ期16例。对各组患者的临床疗效及治疗前后的临床指标、实验室生化指标、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分进行分析。结果 CRRT组肾功能恢复率显著高于IHD组[48.1%(25/52)比21.6%(11/51)],差异有统计学意义(P<0.05)。治疗前CRRT组患者的平均动脉压、血氧饱和度低于IHD组[(69±11)mm Hg(1 mm Hg=0.133k Pa)比(86±14)mm Hg,(0.76±0.10)比(0.89±0.09)],差异有统计学意义(P<0.05),治疗后两组患者平均动脉压、血氧饱和度均较治疗前明显升高(P<0.05)。治疗后CRRT组患者血清肌酐较治疗前明显下降[(272±62)μmol/L比(393±41)μmol/L](P<0.05),且低于IHD组[(391±74)μmol/L](P<0.05);治疗后,CRRT组白蛋白高于IHD组[(32±3)g/L比(30±4)g/L](P<0.05)。结论连续性血液净化治疗可以提高脓毒症导致急性肾损伤患者的存活率,提高患者的肾功能恢复率,同时能改善患者的血流动力学,提高临床治疗效果。对RLFLE诊断标准Ⅰ期患者实施血液净化治疗能取得更好的疗效。Objective To study the therapeutic effect of different methods and timings of blood purifica- tion for the treatment of sepsis-induced acute kidney injury. Methods A retrospective analysis on 103 cases of sepsis-induced acute kidney injury treated in Hubei Medical College Affiliated Dongfeng Hospital from Feb. 2012 to Jun. 2014 was done. They were assigned to the continuous renal replacement therapy（CRRT） group （52cases） and the intermittent hemodialysis （IHD） group （ 51 cases） according to the blood purification method. CRRT group was composed of 15 cases in stage Ⅰ ,20 cases in stage Ⅱ ,17 cases in stage Ⅲ ; IHD group was composed of 15 cases in stage Ⅰ ,20 cases in stage Ⅱ, 16 cases in stage Ⅲ. The clinical curative effect of each group and the clinical index, laboratory biochemical index, acute physiology and chronic health status score Ⅱ（ APACHE Ⅱ ） score were analyzed. Results The recovery rate of renal function in the CRRT group was significantly higher than that in the IHD group [48. 1% （25/52） vs 21.6% （ 11/51 ） ] ,the difference was statistically significant （ P 〈0. 05 ）. Before treatment, the mean arterial pressure and oxygen saturation of the CRRT group were less than the IHD group [ （ 69 ±11 ） mmHg vs （ 86±14 ） mmHg, （0. 76±0. 10） vs （0.89±0.09 ） ] , and the difference were statistically significant （P 〈 0. 05 ）, mean arterial pressure and blood oxygen saturation of the two groups were higher than those before treatment （ P 〈 0. 05 ）. After treatment, serum creatinine of the CRRT group was lower than before treatment [ （272± 62） μmol/L vs （ 393±41 ） μmol/L] （ P 〈 0. 05 ）, and lower than the IHD group [ （ 391±74 ） μmol/L] （ P 〈 0. 05 ） ;after treatment,the albumin in the CRRT group was higher than that of the IHD group[ （32±3） g/L vs （30±4） g/L ] （ P 〈 0. 05 ）. Conclusion Continuous blood purification therapy can improve survival rate and renal function recovery rate of patie

关 键 词：脓毒症 急性肾损伤 连续性肾脏代替 间歇性血液净化 

分 类 号：R459[医药卫生—治疗学]