连续性肾脏替代治疗与间断性血液透析在重症肾综合征出血热治疗中的应用

Application of continuous renal replacement therapy and intermittent hemodialysis in patients with severe hemorrhagic fever with renal syndrome

目的回顾性观察连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)与间断性血液透析(intermittent hemodialysis,IHD)在重症肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者中的应用。方法依据临床分型标准,将2008年1月—2012年8月在我中心行血液净化治疗的147例重症HFRS患者分为重型组和危重型组;参照中华医学会ICU血液净化指南,对纳入患者行CRRT或IHD治疗,比较2组行CRRT或IHD治疗的病死率、并发症发生率和急性期的实验室指标。结果重型组患者均存活;危重型组患者行CRRT与IHD后的病死率比较差异无统计学意义(P=0.124);危重型组行CRRT的比例明显高于重型组(P<0.001)。病程中存在重叠期的重症患者,行CRRT初始治疗的例数明显多于行IHD的例数,但其生存率比较差异无统计学意义(P=1.000)。CRRT组患者病情较IHD组重,其疾病本身的肾外并发症也较IHD组常见。结论 CRRT可广泛应用于危重型HFRS患者的救治。CRRT可有效减轻水负荷,稳定机体的血流动力学状态,将有助于使危重患者平稳地渡过急性期。

Objective To observe the application of continuous renal replacement therapy （CRRT） and intermittent hemodia-lysis （IHD） in patients with severe hemorrhagic fever with renal syndrome （HFRS） retrospectively. Methods Totally 147 severe HFRS patients treated with blood purification in our center from Jan. 2008 to Aug. 2012 were enrolled in the study, and divided into a serious-type group and a critical-type group according to the clinical classification. The patients were treated with CRRT or IHD according to the Chinese Medical Association＆#39;s guideline for blood purification in intensive care unit. The mortality, the occurrence of complications and biochemical parameters during the acute stage were compared between the patients receiving CRRT and IHD in the serious-type group and the critical-type group. Results All the patients in the serious-type group survived. The mortality rates were not significantly different between the patients receiving CRRT and IHD in the critical-type group （P=0.124）. The number of the patients receiving CRRT in the critical-type group was more than that in the severe-type group （P〈0.001）. Among the patients in the overlapping phase, the number of the patients receiving CRRT was more than that of the patients receiving IHD, but the sur-vival rate of these patients receiving CRRT or IHD showed no significant difference （P=1.000）. The clinical condition was worse, and extrarenal complications were more frequent in the CRRT group than those in the IHD group. Conclusions CRRT can be used ex-tensively in the treatment of critical-type HFRS patients. CRRT can relieve water load and improve hemodynamic stability effective-ly, which may contribute to a steady progression in the acute stage of the disease.