持续静脉血液滤过对脓毒血症合并急性肾功能衰竭患者肾功能的影响

Effect of continuous venous hemofiltration on renal function in patients with sepsis and acute renal failure

目的探讨持续静脉血液滤过(CVVH)对脓毒血症合并急性肾功能衰竭(ARF)患者肾功能的影响。方法选取2016年3月—2018年3月脓毒血症合并ARF患者160例,依据随机数字表法分为CVVH组和静脉血液透析滤过(CVVHDF)组,每组80例,CVVH组给予CVVH+基础治疗,CVVHDF组给予CVVHDF+基础治疗,比较2组代谢毒素(乳酸(LA)、内毒素(ET)、β2-微球蛋白(β2-MG))、炎症因子(高敏C-反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α))、肾功电解质(钾、钠、氯)、肾功能(血肌酐(Cr)、尿素氮(BUN))及排尿量、连续肾脏替代治疗时间、死亡情况。结果CVVH组和CVVHDF组治疗后LA、ET、β2-MG、hs-CRP、IL-6、TNF-α、钾、钠、氯、Cr、BUN明显低于治疗前,CVVH组治疗后LA、ET、β2-MG、hs-CRP、IL-6、TNF-α、钾、钠、氯、Cr、BUN明显低于CVVHDF组,差异有统计学意义(P<0.05);CVVH组和CVVHDF组治疗后排尿量明显高于治疗前,差异有统计学意义(P<0.05),CVVH组和CVVHDF组治疗后排尿量、连续性肾脏替代治疗时间、死亡率比较,差异无统计学意义(P>0.05)。结论CVVH治疗脓毒血症合并ARF具有良好的疗效,并可有效改善患者体内毒素、炎症状态及肾功电解质平衡,有利于促进患者肾功能恢复,并可在一定程度上挽救患者生命,值得临床推广。

Objective To discuss the effect of continuous venous hemofiltration(CVVH)on renal function in patients with sepsis and acute renal failure(ARF).Methods 160 patients with sepsis and ARF were selected from March 2016 and March 2018 in Xi’an Chang’an Hospital,according to the random number table method,and they were divided into a CVVH group and venous hemodiafiltration(CVVHDF)group,with 80 cases in each group.The CVVH group was given CVVH+basic treatment,and CVVHDF group was given CVVHDF+basic treatment.The metabolic toxins(lactic acid(LA),endotoxin(ET),beta-2-microglobulin(β-2-MG)),inflammatory factors(high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factoralpha(TNF-α)),renal electrolyte(potassium,sodium,chlorine),renal function(serum creatinine(Cr),urea nitrogen(BUN)),urinary output,duration of continuous renal replacement therapy,mortality rate were compared between the two groups.Results The after treatment by LA,ET,β2-MG,hs-CRP,IL-6,TNF-a,potassium,sodium,chlorine,Cr,BUN in the CVVH group and CVVHDF group were significantly lower than those in the before treatment.The after treatment by LA,ET,β2-MG,hs-CRP,IL-6,TNF-a,potassium,sodium,chlorine,Cr,BUN in the CVVH group were significantly lower than those in the CVVHDF group,the difference being statistically significant(P<0.05).The after treatment urinary output in the CVVH and CVVHDF group was significantly higher than that in the before treatment,the difference being statistically significant(P<0.05).A comparison of the after treatment urinary output,duration of continuous renal replacement therapy,mortality rate between the CVVH and CVVHDF group found no significant difference(P>0.05).Conclusion CVVH has good effect on sepsis complicated with ARF,it can effectively improve the toxin,inflammation and renal electrolyte balance in patients,promote the recovery of renal function of patients,and extensively save the lives of patients,thus worthy of further clinical promotion.