持续血液滤过治疗脓毒血症患者急性肾衰竭临床疗效

Clinical efficacy of continuous hemofiltration in treatment of sepsis patients complicated with acute renal failure

目的研究持续血液滤过治疗脓毒血症并急性肾衰竭的临床疗效,为临床治疗模式选用提供参考。方法选用2011年1月-2012年12月收治的脓毒血症并急性肾衰竭患者63例作为研究对象,根据采用的连续性肾脏替代治疗(CRRT)模式分为观察组36例和对照组27例,观察组采用静脉血液滤过(CVVH)模式治疗,对照组采用静脉血液透析滤过(CVVHDF)模式治疗,观察治疗前和治疗3d后两组患者相关指标;数据采用SPSS18.0统计软件分析。结果治疗3d后,观察组25例患者的心率、呼吸、动脉压3个指标均恢复正常,正常率为69.44%;对照组正常率为66.67%,两组差异无统计学意义;治疗后观察组患者的血尿素氮、肌酐、炎症因子、β2-微球蛋白水平以及APACHEⅡ评分分别为:(13.6±4.5)mmol/L、(168.4±74.5)μmol/L、(85.9±15.4)ng/L、(3.2±1.4)μg/ml和(11.3±4.8)分,对照组的分别为(13.8±4.3)mmol/L、(182.9±83.4)μmol/L、(85.6±15.2)ng/L、(4.1±1.8)μg/ml和(11.6±5.0)分,两组5项指标均比治疗前显著下降,治疗前后的差异有统计学意义(P<0.05)。结论 CVVH清除大分子溶质的效果可能优于CVVHDF,CVVH治疗脓毒血症并急性肾衰竭比CVVHDF治疗可能更有利于患者肾功能恢复。

OBJECTIVE To observe the clinical efficacy of continuous hemofiltration in treatment of sepsis compli- cated with acute renal failure so as to provide guidance for clinical treatment. METHODS A total of 63 patients with sepsis complicated with acute renal failure who were treated in the hospital from Jan 2011 to Dec 2012 were enrolled in the study, then the subjects were divided into the observation group with 36 cases and the control group with 27 cases according to the reception of continuous renal replacement therapy （ CRRT）, the observation group was treated with venous hemofiltration （CVVH） mode, while the control group was given the venous hemodiafil- tration （CVVHDF） mode, the related indicators of the two groups of patients were observed before the treatment and three days after the treatment, and the statistical analysis of data was performed with the use of SPSS18.0 software. RESULTS Three days after the treatment, the three indicators of 25 patients in the observation group, including the heart rate, breath, and arterial pressure, returned to normal with the normal rate of 69. 44%, 66.67% in the control group, and there was not significant difference. After the treatment, the level of blood urea nitrogen was（13.6±4.5）mmol/L in the observation group, （13.8±4.3）mmol/L in the control group; the level of creatinine was （168.4 ±74.5）μmol/L in the observation group, （182.9 ±83.4）μmol/L in the control group; the level of inflammatory cytokines was （85.9 q-15.4）ng/L in the observation group, （85.6 ± 15.2）ng/L in the control group; the level of microglobulin was （3.2±l. 4）μg/ml in the observation group, （4.1±1.8）μg/ml in the control groupl the APACHE Ⅱ score was （11.3±4.8）points in the observation group, （11.6±5.0） points in the control group, all the five indicators of the two groups were significantly reduced, and there was significant difference before and after the treatment （P〈0.05）. CONCLUSION CVVH is superior to CVVHDF in the removal of macromolecular solute; as compared with the CVVHDF therapy for the treatment of sepsis complicated with acute renal failure, the CVVH is more conducive to the recovery of renal function.