连续性与间歇性肾脏替代治疗对多器官功能障碍综合征的临床疗效比较

Effect of continuous versus intermittent renal replacement therapy on the outcome of acute renal failure in patients with multiple-organ dysfunction syndrome

目的:比较连续性与间歇性肾脏替代治疗(renal replacement therapy,RRT)对多器官功能障碍综合征的临床疗效。方法:从2015年10月到2018年3月,选择本院重症监护室(ICU)接受RRT治疗的多器官功能障碍综合征患者作为研究对象。患者随机接受连续性RRT(n=44)与间歇性RRT(n=46)。主要观察指标是RRT结束后28 d的生存率。次要结果指标包括28 d和60 d的院内死亡率,ICU的住院天数,停用RRT的时间,血管加压药/机械通气总天数,疾病严重程度。结果:两组在RRT后28 d生存率,以及28 d、60 d和全因死亡率均无显著差异(P>0.05),并且两组在ICU住院到死亡的时间、ICU住院时间、住院时间、死亡原因、RRT治疗时间、无透析时间、机械通气总时间均无显著差异(P>0.05)。两组之间大多数不良事件的发生率没有显著差异(P>0.05)。与连续性RRT组相比,间歇性RRT组较少发生低体温事件(18.2%vs.4.3%,P<0.05)。结论:在多器官功能障碍综合征的急性肾衰竭患者中,采用连续性RRT或间歇性RRT具有相同的临床疗效。

Objective:To compare the clinical effects of continuous and intermittent renal replacement therapy(RRT)on multiple organ dysfunction syndrome.Methods:From October 2015 to March 2018,patients with multiple organ dysfunction syndrome treated with RRT in our intensive care unit(ICU)were selected as the study subjects.Patients were randomized to receive either CRRT(n=44)or IRRT(n=46).The primary outcome measure was survival 28 days after the end of RRT.Secondary outcome measures included 28-day-,60-day-,all cause intrahospital mortality,days until death(on ICU),days of ICU/hospital stay,days of RRT/dialysis-free days,total days on vasopressors/mechanical ventilation,and course of disease severity.Results:Survival at 28 days after RRT,28-day-,60-day-and all-cause intrahospital mortality rates were not different between the two groups(P>0.05).There were no significant differences in the days until death(on ICU),ICU hospitalization time,hospitalization time,the cause of death,RRT treatment time,dialysis-free time and the total duration of mechanical ventilation between the two groups(P>0.05).There was no significant difference in the incidence of most adverse events between the two groups(P>0.05).Compared with the CRRT group,the IRRT group had fewer hypothermia events(18.2%vs.4.3%,P<0.05).Conclusion:In patients with acute renal failure as part of multiple-organ dysfunction syndrome,CRRT or IRRT has the same clinical efficacy.