不同血液净化模式对合并急性肾损伤的危重患者治疗评价

Evaluation of intermittent high volume on-line hemofiltration versus hemodialysis in the treatment of critically ill patients with acute kidney injury

目的 对照间断高容量前稀释在线血液滤过（HF）和标准血液透析（HD）2种不同的血液净化模式对合并急性肾损伤的危重患者临床预后差异.方法 设计l项单中心、前瞻性、随机对照研究,对照一组合并急性肾损伤的成年危重病患者使用2种不同血液净化模式后死亡率和肾功能恢复率.随访终点为60天的预后,涵盖多因素导致的死亡率,及住院患者死亡率和肾功能的恢复情况.结果 参试95名患者中,血液滤过组50例,血液透析组45例,两组患者基础情况无差异.60天随访结果表明,血液滤过组患者死亡率为68.0％ （34/50）,血液透析组患者为82.2％ （37/45）（危险率0.75;95％可信区间0.80～1.28）,2组患者有统计学显著性差异（P=0.036）,而住院死亡率（P=0.274）以及肾功能恢复率（P=0.565）无统计学显著性差异,住院患者肾功能恢复时间（P=0.223）和需要血液净化治疗比例（P=0.687）均无显著性差异.结论 对于合并急性肾损伤的危重患者,间断高容量前稀释在线HF与血液透析治疗相比,能显著降低死亡率,同时轻度改善肾功能的恢复以及减少血液净化治疗支持频度,但后者没有统计学显著性差异.

Objective To compare clinical effects of intermittent high volume predilution on-line hemofiltration（HF） and standard hemodialysis（HD） in the treatment of critically ill patients with acute kidney injury（AKI）.Methods This was a prospective,randomized controlled,and single-centered clinical study.Mortality and recovery of kidney function were compare in critically ill patients with AKI treated with HF（n=50）and HD（n=45）.The outcome included all-cause mortality and in-hospital all-cause mortality,and recovery rate from AKI within 60 days.Results Baseline characteristics were similar in the HF group and HD group.All-cause mortality within 60 days was 68.0%（34/50） in the HF group and 82.2%（37/45） in the HD group（hazard ratio 0.75;95% confidence interval 0.80～1.28;P=0.036）,while in-hospital mortality and recovery rate from AKI were statistically indifferent between the two groups（P=0.274 and 0.565,respectively）.The recovery time from AKI and the ratio of patients required dialysis were lower in HF group than in HD group but without statistical significance（P=0.223 and 0.687,respectively）.Conclusion HF was better than HD in lowering mortality in critically ill patients with AKI.HF also reduced the recovery time from AKI and the requirement for dialysis support,but without statistical significances as compare with those in HD group.