重度烧伤合并急性肾损伤持续性静脉-静脉血液滤过治疗时机研究  

Early versus late continuous venovenous hemofiltration for severely burned patients with acute kidney injure

作　　者：刘谊蓉 马峰[2] 周美兰[2] 于艳[2] 李洋平 孙世仁[2] 

机构地区：[1]西宁市第一人民医院肾内科,青海西宁810000 [2]第四军医大学西京医院,陕西西安710032

出　　处：《中国急救医学》2016年第10期892-896,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨重度烧伤合并急性肾损伤（acute kidney injure，AKI）持续性静脉-静脉血液滤过（continuous venovenous hemofihration，CVVH）治疗时间的临床研究。方法本研究回顾性分析45例重度烧伤合并AKI后行CVVH治疗的患者，根据KDIGO2012指南对AKI分期作为开始CVVH治疗时机，1期、2期为早期CVVH治疗组，3期为晚期CVVH治疗组。比较两组28d死亡率。亚组观察CVVH治疗前后血流动力学指标及氧合指数（OI）的变化。结果早期和晚期CVVH组基线资料差异均无统计学意义（P〉0．05）。早期较晚期CVVH组明显降低死亡率（40％VS．70％，P=0．045），Kaplain—Meier生存分析显示，早期CVVH组较晚期CVVH组的生存率明显高（P=0．032）。亚组观察18例血流动力学不稳定及机械通气患者，CVVH治疗后较治疗前平均动脉压（mean arterial pressure，MAP），即CVVH治疗前后MAP分别为95mm Hg（84～106mm Hg）VS．58min Hg（47～69mm Hg），P〈0．001）；去甲肾上腺素（norepinephrine，NE），NE分别5，2彬（b·min）（4．0—6，2μg/（kg·min）VS．10．2 μg/（kg·min）（6.8—13．8）μg/（kg·min），P=0．015；多巴胺（dopamine，DA），分别为2．1μg/（kg·min）（0．9～4.3）μg/（kg·min）vs．4．3μg/（kg·min）（3．5—5．1）μg／（kg·min），P=0．021和氧合指数（oxygenation index，OI）分别为220mmHg（173—267mm Hg）VS．125mm Hg（73—177）mmHg，明显改善（P〈0．1301）。结论早期CVVH治疗重度烧伤合并AKI能降低28d死亡率。起到稳定血流动力学和改善氧合指数的作用。Objective This study aimed to evaluate the efficacy of early versus late continuous venovenous hemofiltration （CVVH） for severely burned patients with acute kidney injure. Methods A total of 45 severely burned patients with acute kidney injury who received CVVH treatment. These patients were divided into the early and late CVVH treatment groups by the acute kidney injury network. Twenty - eight - day mortality rate was compared with the two groups. The change of the hemodynamic indexes and oxygenation index were compared before and ＇after CVVH for patients with severely burned patients. Results The baseline characteristics of the included patients were not significantly different in the two groups. Twenty - eight - day mortality rate in the early CVVH group was significantly lower than the late CVVH group （40% vs. 70%, P =0. 045）. And, the accumulated 28 -day survival rate was significantly higher in the early CVVH group （ P = 0. 032 ）. In those hemodynamic instability and mechanical ventilation patients with CVVH treatment, compared with before CVVH treatment, there was a significant increase from baseline in mean arterial pressure [95 mm Hg （84 - 106 mm Hg） vs. 58 mm Hg （47 -69 mm Hg） ,P 〈 0.001 ）] and oxygenation index [ 220 mm Hg （173 - 267 mm Hg） vs. 125 mm Hg （73 - 177 mm Hg） ,P 〈0. 001 ] after CVVH treatment; there was a significant decrease from baseline in norepinephrine [ 5.2 μg/（ kg · （kg · min）6.8 - 13.8 μg/（kg · min） ,P =0.015] min）4. 0 -6. 2 μg/（kg· min） vs. 10. 2 μg/ and dopamine [ 2.1 μg/（ kg · min） 0.9 · 4.3 μg/ （kg· min）vs. 4.3 μg/（kg · min）3.5 -5.1 μg/（kg · min）, P=0.021]. Conclusion The early CVVH treatment of severely burned patients with AKI could improve patient survival. CVVH could stabilize hemodynamies and improve oxygenation index for severely burned patients with hemodynamic instability and mechanical ventilation.

关 键 词：连续性静脉-静脉血液滤过(CVVH) 烧伤 急性肾损伤(AKI) 死亡率 

分 类 号：R692.505[医药卫生—泌尿科学]