两种血液净化方式治疗急性炎症反应综合征合并急性肾损伤  

Therapeutic effects of extended daily hemofiltration and intermittent hemodialysis for systemic inflammatory response syndrome with acute kidney injury

作　　者：冯雪芳[1] 周蓉[1] 徐雅红[1] 张芸[1] 陈闽东[1] 沈杰[1] 

机构地区：[1]同济大学附属杨浦医院肾内科,上海200090

出　　处：《临床肾脏病杂志》2016年第7期423-426,共4页Journal Of Clinical Nephrology

摘　　要：目的比较延长每日血液滤过(extended daily hemofiltration,EDHF)和间断血液透析(intermitent hemodialysis,IHD)治疗全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)合并急性肾损伤(acute kidney injury,AKI)患者的疗效。方法前瞻性收集2010年1月至2013年5月SIRS合并AKI的患者40例,随机数字法分为2组,在常规治疗基础上,分别予以EDHF及IHD(连续诱导透析3 d,之后隔日透析)治疗,比较2组患者的转归(包括院内病死率,肾存活率,住院日及住院费用)。结果①EDHF组院内病死率为15%(3/20)、肾存活率为70%(14/20),IHD组院内病死率为25%(5/20)、肾存活率为45%(9/20),2组比较差异无统计学意义(P>0.05);EDHF组平均住院日为(32.6±8.6)d,IHD组为(39.2±11.5)d,2组比较差异有统计学意义(P<0.05);EDHF组平均住院费用为(28 338.7±8 165.4)元,IHD组平均住院费用为(28 912.9±7443.6)元,2组比较差异无统计学意义(P>0.05)。②第5天EDHF组血肌酐为(243.5±92.8)μmol/L,血尿素氮为(15.6±4.0)mmol/L,IHD组血肌酐为(363.8±209.0)μmol/L,血尿素氮为(17.4±4.6)mmol/L,2组比较差异均有统计学意义(P均<0.05)。结论对于SIRS合并AKI的患者,EDHF治疗的存活率及肾存活率有高于IHD治疗的趋势,EDHF治疗患者住院时间缩短,总治疗费用与IHD治疗相当。Objective To compare the effect of extended daily hemofiltration （EDHF） and in- termittent hemodialysis （IHD） for patients with systemic inflammatory response syndrome （SIRS） and acute kidney injury（AKI）. Methods Forty patients with SIRS and AKI in Yangpu Hospital from Jan. 2010 to May 2013 were collected prospectively. Patients were given EDHF or IHD in addition to the routine management. The following endpoints were measured and compared between two groups： the baseline level, the progression of disease （including mortality rate in hospital, kidney survival rate, length and expenses of hospitalization, and the incidence of disease complications）, the serum BUN and ereatinine levels. Results （1） 17 （85 %） patients in the EDHF group got through the acute phase of disease and 3 （15%） patients did not survive, while in the IHD group 15 （75%） patients sur- vived and 5 （25%） patients died. No significant difference in survival rate was found between the two groups. Fourteen patients （70%） in the EDHF group got rid of dialysis, while in the IHD group, 9 out of 20 （45%） did. There was also no significant difference in kidney survival rate between the two groups. The average days of hospitalization in the EDHF group was （32. 6 ± 8. 6） days, significantly shorter than in the 1HD group （39. 2 ± 11.5） days （P〈0. 05）, but the expenses of hospitalization was comparable between two groups （P〈0. 05）. （2） The creatinine level on the 5th day after hemodialysis in the EDHF group was （243.5 ± 92. 8） μmol/L, significantly lower than that in the IHD group （363.8 ± 209. 0） μmol/L （P〈0. 05）. Conclusions In management of SIRS with AKI, it seemed that the EDHF lowered the mortality rate in hospital and improved the kidney survival rate more efficiently than IHD did, although only the trend but not statistical significance was observed.

关 键 词：延长每日血液滤过 间断血液透析 全身性炎症反应综合征 急性肾损伤 

分 类 号：R692[医药卫生—泌尿科学] R459.7[医药卫生—外科学]