连续性血液净化联合血液灌流治疗中毒合并急性肾损伤的前瞻性研究

Prospective study of continous blood purification combined with hemoperfusion in treatment of acute kidney injury caused by drug toxication

目的研究连续性血液净化(CBP)联合血液灌流(HP)与血液透析(HD)联合血液灌流(HP)治疗中毒合并急性肾损伤(AKI)的临床疗效。方法 68例中毒合并急性肾损伤的住院患者,在常规内科综合治疗基础上随机分组,连续性肾脏替代治疗(CRRT)联合HP治疗组(实验组)33例,HD联合HP治疗组(对照组)35例。实验组与对照组均在治疗的前3天串联HA230树脂罐流器,实验组CRRT治疗模式采用CVVH,每日治疗时间8～12小时,对照组间歇性血液透析(IHD)3天后采用隔日透析,每次治疗时间4小时。两组分别在治疗前及治疗后第1、3、5、7、10、14天抽血查血常规、血生化等并进行组间比较。结果实验组33例患者,7天存活26例(78.8%),14天存活23例(69.7%),对照组35例患者,7天存活24例(68.6%),14天存活19例(54.3%),两组相比有显著性差异(P<0.05)。存活者肾功能均恢复正常。实验组肾功能恢复时间(9.8±2.7)天,对照组肾功能恢复时间[(13.6±4.1)天,P<0.05];实验组平均住院时间(11.2±1.6)天,对照组平均住院时间[(14.7±3.5)天,P<0.05]。结论 CRRT联合HP治疗中毒合并的急性肾损伤有助于肾功能的早期恢复,能一定程度提高中毒患者的生存率,缩短住院时间。

Objective To investigate continuous blood purification（CBP） combined with hemoperfusion（HP） and hemodialysis（HD）and hemoperfusion（HP） in treatment of acute kidney injury caused by drug toxication.Method We chose inpatients in our hospital diagnosed with acute kidney injury caused by drug toxication,which were randomly divided them into experimental group（CRRT＋HP） and control group（HD＋HP）.There were 33 patients in the inexperimental group and 35 in the control group.Both groups were treated with combined HA230-hemoperfuser in the first 3 days.The modle of CRRT was CVVH,8-12h a day.Patients in the control group received intermittent HD（IHD） in the first 3days,then turned into every other day,4 hours every time.Blood routine and biochemical indexes were taken in the 1st,3rd,7th,10th and 14th day.Results In the experimental group,there were 26 survivals（78.8%） until the 7th day,23 survivals（69.7%） until the 14th day,and in the control group,there were 24 survivals（68.6%） until the 7th day,19 survivals（54.3%） until the 14th day.The differences are significant statistically.The renal function recovered in all the survivals.The average recovery time of the experimental group is（9.8±2.7）d,and that of the control group is（13.6±4.1）d（P〈0.05）.The average hospital stay of the experimental group was（11.2±1.6）d,and that of the control group ass（14.7±3.5）d（P〈0.05）.Conclusion CRRT combined with HP is better for the renal function recocery in patients with acute kidney injury caused by drugs.