摘要
目的观察连续低效每日血液透析滤过(SLEDD-f)联合血液灌流(HP)治疗脓毒症急性肾损伤(AKI)的临床疗效。方法选取2008年1月—2011年12月南华大学附属第一医院急诊ICU行连续性肾脏替代治疗(CRRT)或SLEDD-f联合HP治疗的脓毒症AKI患者43例,根据血液净化方式不同分为CRRT组(C组,21例)和SLEDD-f联合HP治疗组(T组,22例),比较两组患者治疗前及治疗后急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、平均动脉压(MAP)、多巴胺(DA)用量、血清肌酐(Scr)、血红蛋白(Hb)、清蛋白(Alb)、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、白介素(IL)-6、IL-10、肿瘤坏死因子α(TNF-α)水平变化,比较两组患者并发症情况及30 d存活率、ICU停留时间。结果治疗前两组患者APACHEⅡ评分、MAP、DA用量及Scr、Hb、Alb、WBC、hs-CRP、IL-6、IL-10、TNF-α水平比较,差异均无统计学意义(P>0.05)。治疗后两组患者MAP、DA用量及Scr、WBC、hs-CRP、IL-6、IL-10、TNF-α水平比较,差异均有统计学意义(P<0.05)。两组患者治疗期间均无严重并发症。C组患者30 d存活率为47.6%(10/21)低于T组的77.3%(17/22)(χ2=4.044,P<0.05)。C组患者ICU停留时间(16.3±5.2)d长于T组的(11.2±3.5)d(t=3.789,P<0.05)。结论SLEDD-f联合HP治疗脓毒症AKI的疗效较CRRT更好,30 d存活率升高,ICU停留时间缩短,为脓毒症AKI患者提供新的治疗方案。
Objective To investigate the clinical efficacy of sustained low-efficiency daily diafiltration（ SLEDD-f） combined with hemoperfusion（ HP）in treatment of sepsis-induced acute kidney injury. Methods A total of 43 patients with sepsis-induced acute kidney injury who received CRRT or SLEDD-f combined with HP treatment in department of emergency, the First Hospital Affiliated to Nanhua University from January 2008 to December 2011,were divided into CRRT group（ C group,21 cases）and LEDD-f combined with HP treatment group（ T group,22 cases）according to various blood purification methods. APCHEⅡ score,mean arterial pressure（ MAP）,dopamine（ DA）dose,levels of serum creatinine（ Scr）,hemo-globin（Hb）,Albumin（Alb）,white blood cell count（WBC）,high-sensitivity C-reactive protein（hs-CRP）,serum IL-6,IL-10 and tumor necrosis factor-α（TNF-α）before and after treatment were compared between two groups. The com-plication rates,30 days survival rates,and the duration of ICU stays were compared between two groups. Results There was no statistical difference in APCHEⅡ score,MAP,DA dose,levels of Scr,Hb,Alb,WBC,hs-CRP,IL-6,IL-10 and TNF-α before treatment between two groups（P .0. 05）. There were significant differences in MAP,DA dose,levels of Scr, WBC,hs-CRP,IL-6,IL-10 and TNF-α after treatment between two groups（P〈0. 05）. Patients in two groups had no serious complications during therapy period. The 30 days survival rate in group C〔47. 6%（10/21）〕was significantly lower than that〔77. 3%（17/22）〕in group T（χ2 =4. 044,P〈0. 05）. The duration of ICU stays in group C〔（16. 3 ± 5. 2） d〕was significantly longer than that in group T〔（11. 2 ± 3. 5）d〕（t=3. 789,P〈0. 05）. Conclusion The clinical efficacy of SLEDD-f combined with HP is better than CRRT in the treatment of sepsis-induced acute kidney injury,and 30 days survival rate is higher,duration of ICU stays is shorter,SLEDD-f combined with HP therapy is a new treatment program for patients with sepsis-induced acute kidney injury.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第24期2810-2813,共4页
Chinese General Practice
