肾替代模式对脓毒症休克合并急性肾损伤的疗效影响

The impact of renal replacement therapy on septic shock patients with acute kidney injury

目的脓毒症休克患者死亡率高,易合并急性肾损伤(AKI),合并AKI死亡率更高。且呈上升趋势。抗休克常规治疗基础上,早期持续肾替代治疗(CRRT),能改善预后。治疗剂量,抗凝方式等都有相关研究提供指导性建议,但是不同治疗模式疗效的比较,在以往的研究中没有被涉及。观察CVVHDF模式和CVVH模式对脓毒症休克合并急性肾损伤患者的疗效影响。方法将2012年1-12月脓毒症休克合并AKI的28位患者随机分为CVVHDF组和CVVH组,给予抗休克常规治疗基础上CRRT治疗,给予相同的血流速度,置换液配方,治疗剂量,和相同的抗凝方案。观察并记录0、24和72 h的APACHEII评分变化,以及死亡率,住ICU时间和住ICU费用。结果 CVVHDF组APACHEII评分为0 h(32.96±9.54)、24 h(26.97±8.35)和72 h(15.29±8.28);CVVH组APACHEII评分为0 h(23.33±9.88)、24 h(25.22±9.25)和72 h(22.7±10.06)。CVVHDF组死亡率50%,CVVH组60%。CVVHDF组住ICU时间(8.20±4.53)d,CVVH组(29.29±15.60)d。CVVHDF组住ICU费用(281 273.56±196 126.81)元,CVVH组(76 969.01±48 010.39)元。结论抗休克治疗同时给予CVVHDF模式CRRT治疗较CVVH模式死亡率更低,缩短住ICU时间,同时降低了住ICU期间费用。CVVHDF模式在治疗脓毒症休克合并AKI患者的效果可能比CVVH模式更好。

【Objective】The mortality rate of patients with septic shock is high.And the patients with septic shock are easily complicated by acute kidney injury（AKI）,septic shock patients with acute kidney injury,resulting in higher mortality.Conventional treatment on the basis of anti-shock,early continuous renal replacement therapy（CRRT） can improve the prognosis.Related research has to provide the guidance recommended therapeutic dose and anticoagulation way,but there is no comparison of the efficacy of different treatment modalities in the previous studies.The impact of the two modes with CVVHDF and CVVH,renal replacement therapy in septic shock patients with acute kidney injury was observed.【Methods】Between January to December,2012,28 patients with septic shock merger of AKI were randomly divided into CVVHDF group and CVVH group,CRRT treatment was given on the basis of conventional treatment of anti-shock,the same blood flow velocity,replacement fluid formulations,therapeutic dose,and the same anticoagulant solution was given.APACHEII score changes,at 0 h,24 h,and 72 h,as well as mortality,duration of ICU stay and ICU costs were observed and recorded.【Results】APACHEII score in CVVHDF group,0 h（32.96±9.54）,24 h（26.97±8.35）,72 h（15.29±8.28）.APACHEII score of CVVH group,0 h（23.33±9.88）,24 h（25.22±9.25）,72 h（22.7±10.06）.Mortality rate of CVVHDF group is 50%,CVVH group,60%.Time stay in ICU in CVVHDF group is（8.20 ± 4.53）d,CVVH group（29.29 ± 15.60）d.The costs of stay in ICU in CVVHDF group is（281 273.56 ± 196 126.81） yuan,and in CVVH Group is（76 969.01 ± 48 010.39） yuan.【Conclusions】Anti-shock treatment while giving CVVHDF mode of CRRT rather than CVVH mode result in lower mor-tality,shorter duration of ICU stay,while reducing the cost of ICU stay period.CVVHDF mode may be better than CVVH mode in AKI patients in the treatment of septic shock combined effect.