间歇性高容量血液滤过治疗严重脓毒症急性肾损伤的疗效观察

Clinical Observation on Intermittent High Volume Hemofiltration Treatment of Septic Acute Kidney Injury

目的：探讨间歇性高容量血液滤过（PHVHF）治疗严重脓毒症急性肾损伤（SAKI）的疗效。方法：我院ICU2011年6月~2014年10月收治的SAKI患者40例,随机分为对照组和治疗组,两组患者均为20例。治疗组给予HVHF60 ml·kg-1·h-1每日治疗8~13 h,对照组给予CVVH 30 ml·kg-1·h-1治疗24~72 h,必要时重复治疗时间,观察治疗前、后两组SAKI患者急性生理学与慢性健康状况（APACHE）Ⅱ评分、血流动力学指标、血清中肿瘤坏死因子α（TNF-α）和白细胞介素-6（IL-6）、血白细胞、C反应蛋白指标、肾功能开始改善时间、ICU住院时间以及60 d生存率。结果：治疗后PHVHF组患者的APACHEⅡ评分、血清中TNF-α和IL-6、血白细胞、C反应蛋白指标、肾功能改善时间、ICU住院时间、60 d生存率与CVVH组差异无统计学意义（P〉0.05）,CVVH组血流动力学指标较PHVHF组差异有统计学意义（P〈0.05）。结论：PHVHF可作为治疗SAKI的有效治疗手段,且经济实用,减少费用、耗材及人力成本。

Objective：To investigate the treatment effectiveness of intermittent high - volume hemofiltration（PHVHF）in patients with septic acute kidney injury（SAKI）. Methods：SAKI patients in our hospital of ICU form June 2011 to October 2014 were treated 40 cases were randomly divided into control and treatment groups,two groups of patients were 20 cases. The treatment group received HVHF 60 ml＆#183;kg - 1 ＆#183;h - 1 daily treatment 8 ~ 13 h,the control group received CVVH 30 ml＆#183;kg - 1 ＆#183;h - 1 treatment 24 ~72 h,if necessary,repeat the treatment period,observed before treatment,after two SAKI group of patients with acute physiology and chronic health evaluation（APACHE）Ⅱ score,hemodynamic parameters,serum tumor necrosis factor - α（TNF - α）and interleu-kin - 6（IL - 6）,white blood cells,C - reactive protein indicators of renal function began to recover time,ICU length of stay and 60 d survival. Results：Group of patients after treatment PHVHF APACHEⅡ score,serum TNF - α and IL - 6,white blood cell, neutrophil proportion（deleted）,C - reactive protein indicators of renal function recovery time,ICU length of stay,60 d survival and CVVH group no difference（P ﹥ 0. 05）,CVVH group hemodynamics PHVHF statistically significant（P ﹤ 0. 05）than group. Con-clusion：PHVHF can be used as an effective treatment for the treatment of SAKI,and economical,reducing costs,supplies and labor costs.