CVVHDF对血液灌流治疗并发急性肾损伤患者肝肾功能及炎症反应的影响  

Effect of CVVHDF on liver and kidney function and inflammatory response in patients with hemoperfusion therapy complicated by acute kidney injury

作　　者：杨玲[1] 吕欣[1] 郑悦[2] 丁琪[2] YANG Ling;LYU Xin;ZHENG Yue(Department of Intensive Care Medicine,Beijing Changping District Hospital,Beijing 102200,China;Department of Intensive Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]北京市昌平区医院重症医学科,北京102200 [2]首都医科大学附属北京朝阳医院重症医学科,北京100020

出　　处：《临床和实验医学杂志》2023年第16期1713-1717,共5页Journal of Clinical and Experimental Medicine

基　　金：北京市自然科学基金面上项目(编号:7182135)。

摘　　要：目的探究连续性静脉-静脉血液透析滤过(CVVHDF)对血液灌注治疗并发急性肾损伤患者肝肾功能及炎症反应的影响。方法前瞻性选取于2018年5月至2022年5月期间在北京市昌平区医院接受血液灌流治疗并发急性肾损伤的患者149例作为本次研究的对象,采用信封法将患者分为对照组75例和观察组74例。对照组患者行常规治疗联合连续性静脉-静脉血液滤过(CVVH)治疗,观察组患者行常规治疗联合CVVHDF治疗。计算两组患者连续性肾脏替代治疗(CRRT)剂量,采用急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)及多器官功能障碍综合征(MODS)评分对患者的治疗效果进行评估,比较两组患者治疗前后的肝肾功能指标[丙氨酸转移酶(ALT)、天冬氨酸转移酶(AST)、血淀粉酶、血肌酐、尿素氮]及血清炎症因子[肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、白细胞介素(IL)-6、IL-8]水平。结果两组患者Kp均为40.00 mL·kg^(-1)·h^(-1),观察组患者Kpc、Kc、K值均大于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者APACHEⅡ评分及MODS评分均较治疗前降低,且观察组APACHEⅡ评分及MODS评分均低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者的ALT、AST、血淀粉酶、血肌酐、血尿素氮水平均较治疗前降低,且观察组的ALT、AST、血淀粉酶、血肌酐、血尿素氮水平均低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者的TNF-α、CRP、IL-6、IL-8水平均较治疗前降低,且观察组TNF-α、CRP、IL-6、IL-8水平均低于对照组,差异均有统计学意义(P<0.05)。结论采用CVVHDF对接受血液灌流治疗并发急性肾损伤患者进行治疗,相同Kp时的实际CRRT剂量大于CVVH,可以更有效地改善患者的肝肾功能、降低体内炎症因子水平,有较好的临床应用效果。Objective To explore the effect of continuous venous-venous hemodiafiltration(CVVHDF)on liver and kidney function and inflammatory response in patients with blood perfusion treatment complicated by acute kidney injury.Methods A total of 149 patients with acute kidney injury treated in Beijing Changping District Hospital from May 2018 to May 2022 were retrospectively selected as the subjects of this study.Patients were divided into a control group of 75 cases and an observation group of 74 cases using the envelope method.Patients in the control group were treated with conventional therapy plus continuous veno-venous hemofiltration(CVVH).Patients in the observation group who received conventional therapy combined with CVVHDF therapy.Continuous renal replacement therapy(CRRT)dose was calculated in both groups.The treatment effect of patients was evaluated by the acute physiology and chronic health evaluationⅡ(APACHEⅡ)and the multiple organ dysfunction syndrome(MODS).The levels of liver and kidney function indexes[aspartate aminotransferase(AST),alanine aminotransferaseaspartic(AST),blood amylase,blood creatinine,blood urea nitrogen]and serum inflammatory factors[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),and IL-8]were compared.Results The Kp of both groups of patients was 40.00 mL·kg^(-1)·h^(-1),and the Kpc,Kc,and K values of the observation group were higher than those of the control group,the differences were statistically significant(P<0.05).After treatment,the APACHEⅡand MODS scores of the two groups of patients decreased compared to before treatment,and the APACHEⅡand MODS scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).After treatment,the ALT,AST,blood amylase,blood creatinine,and blood Blood urea nitrogen of the two groups were lower than those before treatment,and the ALT,AST,blood Amylase,blood creatinine,and blood urea nitrogen levels of the observation group were lower than tho

关 键 词：血液透析滤过 血液滤过 血液灌流治疗 急性肾损伤 肝肾功能 炎症反应 

分 类 号：R692.5[医药卫生—泌尿科学]