不同血液净化方式治疗脓毒症致急性肾损伤的疗效对比  

Comparison of different blood purification methods in the treatment of sepsis acute kidney injury

作　　者：汪一帆[1] 白祥琰 艾芬[1] 李维[1] 桂峰[1] 刘振兴[1] 

机构地区：[1]华中科技大学同济医学院附属武汉中心医院急诊科,武汉430014

出　　处：《临床急诊杂志》2017年第6期420-423,共4页Journal of Clinical Emergency

摘　　要：目的:探讨不同血液净化方式在治疗脓毒症致急性肾损伤(AKI)患者中的临床疗效情况。方法:选择2014-01-2016-01在我院就诊的84例脓毒症致AKI患者,按照随机原则分为2组,其中42例采用连续性肾脏替代治疗(CRRT组),另42例患者采用持续低效血液透析联合血液灌流治疗(联合组),对比2组APACHEⅡ评分、MAP、DA用量、Scr、Hb、Alb、WBC以及相关炎性因子变化水平,同时对患者的并发症发生率、30d存活率和ICU住院时间进行统计对比。结果:2组患者治疗前的APACHEⅡ评分、MAP以及各项指标比较差异无统计学意义,而在治疗后,2组患者的APACHEⅡ、MAP、DA、Scr、WBC、IL-6、IL-10、TNF-α比较差异有统计学意义(P<0.05)。2组患者在治疗后均未出现明显并发症。此外,CRRT组患者存活率42.86%(18/42)明显低于联合组78.57%,差异有统计学意义(P<0.05)。且联合组患者在ICU住院时间要明显短于CRRT组,差异有统计学意义(P<0.05)。结论:相对于CRRT,持续低效血液透析联合血流灌注对脓毒症致AKI患者治疗效果较高,可能具有控制炎症、改善肾功能的效果,一定程度上降低了患者病死率,但具体疗效有待进一步大样本多中心研究进行验证。Objective：To investigate the clinical effects of different blood purification methods in treating sepsis patients with acute kidney injury.Method：84patients with acute kidney injury caused by sepsis in our hospital from January 2014 to January 2016 were randomly divided into two groups.42 patients were treated with continuous renal replacement therapy（CRRT group）,and another 42 patients were treated with sustained low-efficiency dialysis combined with hemoperfusion（combined group）.The levels of APACHE Ⅱ,MAP,DA,Scr,Hb,Alb and WBC in the two groups were compared.In the same time,the incidence of complications,30 dsurvival rate and ICU stay time were statistically compared.Result：There was no significant difference in APACHE Ⅱ,MAP and other indexes between the two groups before treatment（P〈0.05）.There were significant differences in APACHE Ⅱ,MAP,DA,Scr,WBC,IL-6,IL-10 and TNF-αbetween the two groups after treatment（P〈0.05）.There was no significant complication in the two groups after treatment.In addition,the survival rate was significantly lower in the CRRT group（42.85%）than that in the combined group（78.57%）（P〈0.05）.The ICU stay time in combined group was significantly shorter than that in CRRT group（P〈0.05）.Conclusion：Comparing to simple continuous renal replacement therapy,sustained low-efficiency dialysis combined with hemoperfusion in treating acute kidney injury caused by sepsis may be more effective on controlling inflammations,improving renal function and other related indicators,but also can shorten the ICU residence time,which was worthy of clinical promotion.

关 键 词：血液净化 脓毒症 急性肾损伤 连续性肾脏替代治疗 血液灌流 血液透析 

分 类 号：R459.7[医药卫生—急诊医学]