不同滤器对脓毒症相关性急性肾损伤患者疗效的影响  

Effect of different filters on the efficacy in patients with sepsis-associated acute kidney injury

作　　者：周文杰[1] 赵恬 马琪 马希刚[1] Zhou Wenjie;Zhao Tian;Ma Qi;Ma Xigang(Department of Intensive Care Unit,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Intensive Care Unit,Xingyuan Hospital of Yulin,Yulin 719000,Shaanxi,China;Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学总医院重症医学科,银川750004 [2]榆林市星元医院重症医学科,陕西榆林719000 [3]宁夏医科大学,银川750004

出　　处：《中华危重病急救医学》2025年第1期48-52,共5页Chinese Critical Care Medicine

基　　金：宁夏回族自治区重点研发计划项目(2021BEG03094);宁夏自然科学基金(2022AAC03489)。

摘　　要：目的探讨在连续性肾脏替代治疗(CRRT)中使用不同滤器对脓毒症相关性急性肾损伤(SA-AKI)患者病死率、炎症介质水平及血流动力学的影响。方法采用前瞻性研究方法,选择2022年8月至2023年10月宁夏医科大学总医院重症医学科收治的首次接受CRRT治疗的SA-AKI患者作为研究对象,采用随机数字表法分为观察组和对照组。所有患者均接受包括抗感染、容量管理优化及器官功能支持在内的常规治疗;在此基础上,观察组使用oXiris滤器进行CRRT治疗,而对照组则采用普通滤器进行CRRT治疗,首次治疗时间均≥36 h。收集并比较两组患者一般资料,同时分别收集CRRT治疗前及治疗24 h、48 h炎症指标〔超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)〕、序贯器官衰竭评分(SOFA)、平均动脉压(MAP)、血乳酸(Lac)、去甲肾上腺素剂量等相关指标,并记录患者7 d和28 d病死率。结果最终共纳入65例患者,其中观察组30例,对照组35例;两组患者年龄、性别、急性肾损伤(AKI)分期、感染来源等基线数据差异均无统计学意义。观察组患者7 d病死率显著低于对照组〔16.7%(5/30)比42.9%(15/35),P<0.05〕;观察组与对照组28 d病死率差异无统计学意义〔36.7%(11/30)比54.3%(19/35),P>0.05〕。两组患者治疗前炎症指标、SOFA评分、MAP、Lac、去甲肾上腺素剂量差异均无统计学意义;治疗24 h和48 h两组患者血流动力学均较治疗前稳定,炎症指标、SOFA评分、Lac、去甲肾上腺素剂量均较治疗前不同程度降低,MAP较治疗前显著升高,其中观察组hs-CRP、PCT、IL-6、SOFA评分、MAP、去甲肾上腺素剂量于治疗24 h即显示出统计学意义〔hs-CRP(mg/L):125.0(105.0,171.2)比280.5(213.2,313.8),PCT(μg/L):51.0(20.0,62.8)比71.0(10.8,100.0),IL-6(ng/L):1762.2(300.8,4327.5)比4447.5(630.4,5000.0),SOFA评分(分):13.0(12.0,14.0)比16.0(15.0,17.0),MAP(mmHg,1 mmHg≈0.133 kPa):79.00±12.87比65.20±11.70,去甲�Objective To investigate the effects of using different filters in continuous renal replacement therapy(CRRT)on the mortality,inflammatory mediator level and hemodynamics in patients with sepsis-associated acute kidney injury(SA-AKI).MethodsA prospective study was conducted.The patients with SA-AKI undergoing first CRRT admitted to the critical care medicine department of General Hospital of Ningxia Medical University from August 2022 to October 2023 were enrolled as the study objects,and they were divided into observation group and control group by random number table method.All patients received routine treatment including anti-infection,optimized volume management and organ function support.On this basis,the observation group was treated with oXiris filter for CRRT,while the control group was treated with ordinary filter for CRRT,and the first treatment time was≥36 hours.General data of the two groups were collected and compared.At the same time,the inflammatory indicators[high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),interleukin-6(IL-6)],sequential organ failure assessment(SOFA)score,mean arterial pressure(MAP),blood lactic acid(Lac),noradrenaline dosage and other related indicators were collected before CRRT treatment and 24 hours and 48 hours after treatment,and the 7-day and 28-day mortality of patients were recorded.ResultsFinally,65 patients were enrolled,including 30 in the observation group and 35 in the control group.There were no significant differences in baseline data including age,gender,acute kidney injury(AKI)stage and infection source between the two groups.The 7-day mortality of observation group was significantly lower than that of control group[16.7%(5/30)vs.42.9%(15/35),P<0.05].There was no significant difference in 28-day mortality between the observation group and the control group[36.7%(11/30)vs.54.3%(19/35),P>0.05].There were no significant differences in inflammation indicators,SOFA score,MAP,Lac and norepinephrine dosage before treatment between the two groups.After

关 键 词：脓毒症 急性肾损伤 滤器 血液净化 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]