摘要
目的观察间隙性高容量血液滤过(HVHF)在脓毒症合并急性肾损伤(AKI)患者救治中的临床疗效。方法选择32例脓毒症合并AKI患者,其中男性19例,女性13例;年龄29~76岁,平均年龄57.4岁。按照接受血液净化治疗模式不同分为观察组和对照组。观察组18例,其中男性11例,女性7例,年龄(55.3±14.8)岁,体质量(57.7±10.4) kg;对照组14例,其中男性8例,女性6例,年龄(60.1±13.3)岁,体质量(58.1±14.9) kg。对比分析两组血液净化治疗前、治疗12 h及72 h生命体征变化、危重症评分、全身炎症反应指标、血乳酸指标、血清生物化学指标及肾功能,比较两组患者机械通气时间、28 d存活率、透析器凝血情况。结果两组患者治疗后生命体征变化、危重症评分、全身炎症反应指标、血乳酸指标、血清生物化学指标及肾功能指标较治疗前比较,差异有统计学意义(P <0.05);观察组在治疗12 h时各项生命体征变化、危重症评分及全身炎症反应等指标较对照组明显改善(P <0.05);观察组在治疗72 h后全身炎症反应指标较对照组明显改善(P <0.05)。两组机械通气时间比较(8.1 d±3.8 d vs 10.5 d±6.3 d),差异有统计学意义(P <0.05);28 d存活率比较(72.20%vs 57.15%),差异无统计学意义(P> 0.05)。结论间隙性HVHF可以有效清除脓毒症患者炎性介质,显著改善临床症状,降低人力消耗,减少并发症发生率,提高治疗效果。
Objective To assess the therapeutic effect of interstitial high volume hemofiltration(HVHF)in treatment of sepsis patients complicated with acute kidney injury(AKI).Methods A total of 32 sepsis patients complicated with AKI were enrolled,included 19 males and 13 females,aged 29-76 years old with mean age of 57.4 years old.They were divided into observation group[n=18,11 males and 7 females,aged(55.3±14.8)years old with body weight of(57.7±10.4)kg]and control group[(n=14,8 males and 6 females,aged(60.1±13.3)years old with body weight of(58.1±14.9)kg]by blood purification treatment mode.The vital signs,critical illness scores,systemic inflammation indicators,blood lactate index,serum biochemical parameters and renal function before treatment,12-hour and 72-hour after treatment,mechanical ventilation time,28-day survival rate and dialyzer coagulation were compared between 2 groups.Results The changes of vital signs,critical illness scores,systemic inflammation index,blood lactate index,serum biochemical index and renal function index between 2 groups were statistically significant(P<0.05).At 12 hours after treatment,the changes of vital signs,critical scores and inflammatory response in observation group were significantly better than those of control group(P<0.05).At 72 hours after treatment,the systemic inflammation index in observation group was significantly better than that of control group(P<0.05).There was statistically significant difference in mechanical ventilation time(8.1 d±3.8 d vs 10.5 d±6.3 d)between 2 groups(P<0.05).There was no significant difference in 28-day survival rate(72.20%vs 57.15%)(P>0.05).Conclusion It is demonstrated that interstitial HVHF could effectively eliminate inflammatory mediators in patients with sepsis,significantly improve the clinical symptoms and treatment effect,reduce human consumption and incidence of complications.
作者
张衡
朱梦莉
朱维芳
王智超
ZHANG Heng;ZHU Meng-li;ZHU Wei-fang;WANG Zhi-chao(Department of Emergency Medicine,Wuhan No.1 Hospital,Wuhan 430022,Hubei,China)
出处
《生物医学工程与临床》
CAS
2019年第1期35-40,共6页
Biomedical Engineering and Clinical Medicine
关键词
连续性血液净化
高容量血液滤过
重症脓毒症
急性肾损伤
continuous blood purification
high volume hemofiltration
severe sepsis
acute kidney injury
