持续低效每日透析治疗急性肾损伤的临床研究

Clinical study for acute kidney injury patients treated with sustained low-efficiency daily dialysis

目的探讨持续低效每日透析（SLEDD）治疗急性肾损伤的疗效和安全性。方法选择住院并接受血液净化治疗的急性肾损伤（AKI）患者76例，分为SLEDD、间歇性血液透析（IHD）和持续静静脉血液滤过（CVVH）三组，其中SLEDD组21例，IHD组27例，CVVH组28例。比较三组患者接受血液净化前的基础病情，采集3种血液净化治疗模式对急性肾损伤患者血流动力学，溶质清除，水、电解质和酸碱平衡，疾病转归影响和抗凝剂用量的指标进行统计学处理。结果三组患者基础病情比较差异无统计学意义（P〉0．05）；SLEDD、CVVH组血流动力学不稳定的发生率比较差异无统计学意义（P〉0．05），SLEDD、IHD组比较差异有统计学意义（P〈O．01），IHD组因血流动力学不稳定引起的单次透析中断率为33．27％；三组尿毒症毒素清除、电解质（除血K’差值SLEDD较CVVH组下降）及酸碱差异均无统计学意义（P〉0．05），日液体出入量、超滤量SLEDD组较IHD组增多（P〈0．05），抗凝剂量SLEDD组较CVVH组减少（P〈0．01）；存活率及肾功能恢复时间SLEDD组优于IHD组。结论SLEDD比较IHD治疗急性肾损伤血流动力学相对稳定、病死率低、溶质清除及超滤充分；比较CVVH血流动力学、溶质清除及超滤量差异无统计学意义，抗凝剂用量减少。

Objective To investigate the effectiveness and safety of sustained low-efficiency dai- ly dialysis（SLEDD） in patients with acute kidney injury （AKI）. Methods Seventy-six hospitalized pa- tients with acute kidney injury who requiring blood purification were selected. All patients were divided into three groups according to blood purification methods, 21 patients in group SLEDD （ sustained low-ef- ficiency daily dialysis）, 27 patients in group IHD（ intermittent homodialysis）, 28 patients in group CV- VH （ continuous veno-venous hemofihration）. Data included primary disease, gender, age, APACHEII （ acute physiology and chronic health evaluation Ⅱ） score, number of dysfunction organs, AKI classifca- tion, time from onse of AKI to receiving blood purification were observed before blood purification. The in- dices of hemodynamics, solute clearance, water-electrolyte and acid-base metabolism, prognosis of dis- ease and anticoagulant dosage were collected, then the data be treated statistically. Results The pa- tient＇ s condition had no statistically significant difference （P 〉 0.05 ）. There were no difference or sig- nificant difference between group SLEDD and CVVH or group SLEDD （P 〉 0.05 ）, and IHD in rates of hemodynamic instability （P 〈 0.01 ）, and the exiting rates in group IHD were 33.27% for hemodynamic deterioration, while in groups SLEDD and CVVH no exit. Also there were no difference about solute clearance, water-electrolyte and acid-base metabolism among the three groups, but anticoagulant dosage in group SLEDD was less than that in group CVVH. About survival rate and renal functional restoration, group SLEDD was better than group IHD. Conclusions SLEDD had some advantage in haemodynamic stabilization, low mortality rate, sufficient solute clearance and ultrafihration than IHD, also some forte less anticoagulant dosage than CVVH.