持续静静脉血液滤过和持续低效每日透析治疗重症急性肾损伤的临床研究

Comparison of continuous veno-venous hemofiltration and sustained low-efficiency daily dialysis for the treatment of critical patients with acute kidney injury

目的探讨持续静静脉血液滤过(continuous veno-venous hemofiltration,CVVH)与持续低效每日透析(sustained low-efficiency daily dialysis,SLEDD)治疗重症急性肾损伤的疗效和安全性。方法回顾性分析了四川省人民医院重症监护室41例合并急性肾损伤行血液净化治疗患者,其中CVVH组18例,SLEDD组23例,调查患者性别、年龄、原发病、治疗前急性生理学与慢性健康状况评分(acutephysiology and chronic health evaluation,APACHE)Ⅱ、脏器衰竭数、急性肾损伤分级;血液净化治疗模式和剂量、血管通路、抗凝方式等。研究2种肾替代治疗模式对重症急性肾损伤患者血流动力学、溶质清除、电解质和酸碱平衡、疾病转归以及卫生经济学的影响。结果 2组间年龄、性别、脏器衰竭数、急性肾损伤分级差异无统计学意义(P>0.05),但CVVH组APACHEⅡ分值明显高于SLEDD组(P<0.05),死亡率也高于SLEDD组;比较SLEDD组(128次)与CVVH组(87次)透析记录,对血液动力学影响2组间差异无统计学意义(P>0.05);2组治疗前后电解质(除血钾外)和酸碱的差异无统计学意义(P>0.05),抗凝剂使用CVVH组明显高于SLEDD组(P<0.01),CVVH组治疗的日超滤量、液体入量和液体出量明显高于SLEDD组(均P<0.01),CVVH组治疗的工作时间、夜班时间和费用明显高于SLEDD组(P<0.01)。结论 SLEDD使用相对短的时间、更少的抗凝剂,以较低的成本基本达到与CVVH治疗相当的效果。

Objective To observe the effectiveness and safety of continuous veno-venous hemofiltration （CVVH） and sustained low-efficiency daily dialysis （SLEDD） in critical patients with acute kidney injury （AKI）. Method We retrospectively analyzed 41 AKI patients treated with CVVH （n=18） or SLEDD （n=23） in the 2 ICUs in this hospital. Data for analysis included gender, age, primary disease, APACHEII score, number of dysfunction organs, AKI classification, blood purification modality and dose, vascular access, and anticoagulant used. Results There were no differences in age, gender, number of failure organs and AKI classification between CVVH and SLEDD groups （P〉0.05）. APACHE II score was significantly higher in CVVH group than in SLEDD group （P = 0.03）. Hemodynamic instability was found in 52.6% in CVVH group （a total of 128 times of CVVH in 23 cases） and 47.3% in SLEDD group （a total of 87 days in 18 cases; P〉0.05）. Electrolyte concentrations had no significant differences before and after the dialysis in the two groups （P〉0.05）. More anticoagulants were used in CVVH group than in SLEDD group （P〈0.01）. Daily ultrafiltration volume, water uptake and excretion were significantly higher in CVVH group than in SLEDD group （P〈0.01）, so as the service time, working time at night and money expense （P〈0.01）. Conclusion SLEDD can be conducted in a shorter period of time, using less anticoagulant and at a lower cost, while brings similar effects as CVVH.