持续缓慢低效血液透析治疗在糖尿病肾脏疾病合并多器官功能衰竭患者中的应用

Sustained Low Efficiency Dialysis on Patients with Multiple Organ Failure Resulted from Diabetic Kidney Disease

目的分析持续缓慢低效血液透析(sustained low efficiency dialysis,SLED)在糖尿病肾脏疾病(diabetic kidney disease,DKD)合并多器官功能衰竭患者中的应用。方法回顾性分析四川大学华西医院收治的5例糖尿病肾脏疾病〔CKD(chronic kidney diseases)5期〕合并多器官功能衰竭的患者,采用SLED的方式隔日治疗8～12h,透析量200mL/min,同时给予原发病、抗感染对症支持治疗。观察患者SLED治疗前后各项临床检测指标的变化及疾病转归。结果 1例患者入院后12h内因多器官功能衰竭死亡。余4例患者经SLED干预治疗24h后高钾血症和(或)代谢性酸中毒均得以纠正(P<0.05),脏器功能逐渐恢复,血压稳定,氧合指数改善〔SLED治疗后5d氧分压(103.3±25.7)mmHg,1mmHg=0.1333kPa〕,2例使用呼吸机的患者均在3～5d后停用无创呼吸机,血清BNP水平由治疗前>35 000pg/mL下降至治疗后5d的(13312±3575)pg/mL,差异有统计学意义(P<0.05)。急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分分别在治疗后24h、3d、5d后下降10.3%、41.9%和67.8%。结论 SLED干预DKD合并多器官功能衰竭能获得满意疗效,在危重患者的抢救治疗中其治疗效果可能与持续肾脏替代治疗(continuous renal replacement therapy,CRRT)相当。

Objective To investigate the effect of sustained low efficiency dialysis（SLED） on patients with multiple organ failure resulted from diabetic kidney disease（DKD）.Methods Five DKD patients who developed MOF between Nov.2011 and Jan.2012 were recruited for SLED treatment（dose： 200 ml/min,for 8 to 12 hours every other day） in the West China Hospital.Meanwhile,other therapeutic measures,such as underlying disease management,infection control and nutritional support were applied.Biochemical changes and progress of disease were observed.Results One patient died unexpectedly 12h after admission to hospital.The main cause of death was multiple organ failure.The other four patients had sharp improvements in high potassium concentration and（or） metabolic acidosis after SLED therapy,with obvious amelioration of main organs functions and oxygenation index（PO2（103.3±25.7） mm Hg）.Two ventilator dependent patients successfully weaned from mechanical ventilation 3 to 5 days after the treatment.BNP of the patients decreased from 35 000 ng/mL before the treatment to（13312±3537） pg/mL after the treatment（P0.05）.APACHE Ⅱ decreased by 10.3%,41.9% and 67.8% within 24 hours,three days and five days respectively.Conclusion SLED as early intervention can bring significant benefits to DKD patients with multiple organ failure（MOF）.SLED has the same efficacy as continuous renal replacement therapy（CRRT） in the treatment of MOF for patients with DKD.