延长每日血液透析治疗急性肾衰竭的临床效果  

Clinical Effect of Extended Daily Hemodialysis on Acute Renal Failure

作　　者：张茜[1] 胡莹[1] 郝丽荣[1] ZHANG Xi;HU Ying;HAO Lirong(Department of Nephrology,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院肾内科,哈尔滨150001

出　　处：《医学综述》2020年第22期4562-4567,共6页Medical Recapitulate

摘　　要：目的探讨延长每日血液透析对于急性肾衰竭患者临床转归的影响。方法回顾性分析2014年1月至2019年1月哈尔滨医科大学附属第一医院收治的318例急性肾衰竭患者的临床资料,其中129例患者接受间断血液透析(IHD),113例患者接受延长每日血液透析(EDD)治疗,76例患者接受间断肾脏替代治疗(IRRT)。IHD组血流量180~270 mL/min,每次4 h,隔日1次;EDD组血流量150~200 mL/min,每次透析6 h,每日1次;IRRT组血流量180 mL/min,每次8 h,隔日1次。比较各组患者的临床疗效,尿素清除指数、β2微球蛋白(β2-MG)下降幅度,治疗前后血清离子(K^+、Na^+、Ca^2+)和HCO3^-水平,血流动力学稳定率及24 h尿量恢复正常时间、住院时间和治疗费用。结果IHD组、EDD组、IRRT组总有效率分别为89.2%(115/129)、97.3%(110/113)、98.6%(75/76),EDD组、IRRT组总有效率高于IHD组(P<0.05)。与IHD组相比,EDD和IRRT组尿素清除指数明显升高(P<0.01),EDD组和IRRT组β2-MG下降幅度加大(P<0.01)。K^+、Na^+、Ca^2+和HCO3^-的组间和时点间存在交互作用(P<0.01),IHD和EDD组治疗前后K^+、Na^+、Ca^2+和HCO3^-波动幅度相对较大,IRRT组相对较小。IHD组MAP波动幅度小于20%的比例为57.4%(74/129),EDD组为84.1%(95/113),IRRT组为86.8%(66/76),EDD组和IRRT组高于IHD组(P<0.01)。EDD和IRRT组24 h尿量恢复正常时间、住院时间短于IHD组,IRRT组短于EDD组(P<0.01);EDD组和IRRT组治疗费用高于IHD组,IRRT高于EDD组(P<0.01)。结论EDD模式能够有效清除肌酐、尿素氮等尿毒症毒素,减少并发症发生,缩短住院时间,减少治疗费用,操作简单,是一种安全、有效、经济、方便的肾脏替代模式。Objective To explore the effect of extended daily hemodialysis on clinical outcome of patients with acute renal failure.Methods The clinical data of 318 patients with acute renal failure admitted to the First Affiliated Hospital of Harbin Medical University from Jan.2014 to Jan.2019 was retrospectively analyzed,of which 129 patients were treated with intermittent hemodialysis(IHD),113 patients were treated with extended daily hemodialysis(EDD),76 patients were treated with intermittent renal replacement therapy(IRRT).Parameters of renal replacement therapy:IHD group,blood flow 180-270 mL/min,4 hours each time,once every other day;EDD group,blood flow 150-200 mL/min,6 hours each time,once a day;IRRT group,blood flow 180 mL/min for 8 hours at a time,once every other day.The data of urea clearance index,the range ofβ2-microglobulin(β2-MG)decrease,amplitude of serum ion(K^+/Na^+/Ca^2+)and HCO3^- before and after treatment,the recovery time of 24 hours urine volume,the average hospitalization time/cost,and the fluctuation range of mean arterial pressure and clinical efficacy of each group were compared.Results Total effective rate in the IHD group,EDD group and IRRT group was 89.2%(115/129),97.3%(110/113),98.6%(75/76)respectively,that of the EDD group and IRRT group was higher than that of the IHD group(P<0.05).Compared to the IHD group,the urea clearance index of the EDD and IRRT groups increased significantly(P<0.01),the decrease ofβ2-MG in the EDD group and IRRT group increased(P<0.01).There was interaction in K^+,Na^+,Ca^2+and HCO3^- between groups and time points(P<0.01),K^+,Na^+Ca^2+and HCO3^- fluctuations before and after treatment in the IHD group and EDD group were relatively large,in the IRRT group was relatively small.The proportion of MAP fluctuations of less than 20%was 57.4%(74/129)in the IHD group,84.1%(95/113)in the EDD group,86.8%(66/76)in the IRRT group,the EDD group and IRRT group higher than the IHD group(P<0.01).24 h urine volume returned to normal time and hospital stay of the EDD and IRRT gro

关 键 词：急性肾衰竭 间断血液透析 延长每日血液透析 间断肾脏替代治疗 

分 类 号：R459.5[医药卫生—治疗学]