连续性血浆滤过联合血浆吸附治疗脓毒症急性肾损伤的临床研究

Effectiveness of continuous plasma filtration combined with plasma adsorption for the septic acute kidney injury

目的探讨连续性血浆滤过联合血浆吸附治疗脓毒症急性肾损伤(acute kidney injury,AKI)的治疗效果。方法根据纳入排除标准,124例脓毒症AKI患者作为研究对象,随机分为观察组和对照组,每组62例。对照组予连续性血液滤过治疗,治疗时间24~72 h,血流速度150~180ml/min;观察组予连续性血浆滤过联合血浆吸附治疗,治疗时间血浆吸附每天3 h,血浆滤过24~72h,血流速度150~180 ml/min,比较2组患者28 d生存率、ICU入住时间、依赖呼吸机时间以及治疗前、后生命体征、氧合指数、IL-6、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素1β、白细胞介素10、血肌酐、尿素氮、白细胞及急性生理学与慢性健康情况评价系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)。结果 2组患者治疗后生命体征、白细胞介素6、TNF-α、白细胞介素1β、白细胞介素10、氧合指数、血肌酐、尿素氮、白细胞及APACHE II评分等均明显改善(P<0.05)。与对照组相比,观察组患者28 d生存率显著提高(72.58%比46.77%,P<0.05),治疗后氧合指数改善更明显[(362.56±98.25)比(82.84±105.38),P<0.05],血肌酐[(61.47±10.65)比(79.30±11.75)μmol/L,P<0.05]、尿素氮[(8.69±3.61)比(14.06±3.76)mmol/L]、白细胞[(11.80±4.51)×10~9/L比(14.53±5.09)×10~9/L,P<0.05]、白细胞介素6[(62.63±45.25)ng/ml比(112.38±66.23)ng/ml]、TNF-α[(23.62±4.27)ng/ml比(34.82±5.29)ng/ml]、白细胞介素1β[(32.52±8.32)ng/ml比(46.15±9.52)ng/ml]、白细胞介素10[(295.21±106.28)ng/ml比(361.78±102.03)ng/ml],生命体征改善明显(P<0.05),APACHE II评分(11.62±3.71)比(14.36±3.52)、ICU入住时间[(15.69±3.51)比(18.92±3.27)d]及依赖呼吸机时间[(4.68±3.10)比(6.83±3.21)d]明显减少(P<0.05)。结论连续性血浆滤过联合血浆吸附治疗可有效降低脓毒症AKI患者细胞炎性因子水平,改善患者预后。

Objective To investigate the effectiveness of continuous plasma filtration combined with plasma adsorption in the treatment of acute renal injury caused by sepsis. Methods 124 cases of septic AKI were randomly divided into experimental group and control group（ 62 cases in each group）. The control group was given continuous hemofiltration treatment for 24 - 72 h and 150 - 180 ml/min of blood fluid,and the experimental group was given continuous plasma filtration（ 24 - 72 h） combined with plasma adsorption（ 3 h） and 150 - 180 ml/min of blood fluid. The 28-day survival rate,ICU stay and ventilator dependent time were compared between two groups,and the levels of IL-6,TNF-alpha,IL-1beta,IL-10,blood creatinine and blood urea nitrogen,vital signs,oxygenation index,white blood cell count,APACHE II score werecompared before and after treatment. Results The levels of IL-6,TNF-alpha,IL-1beta,IL-10,blood creatinine and blood urea nitrogen,vital signs,oxygenation index,white blood cell count,and APACHE II score were significantly improved after treatment in the two groups. The 28-day survival rate in the experimental group（ 72. 58%） was significantly higher than in the control group（ 46. 77%）. ICU stay（ 15. 69 ±3. 51 vs 18. 92 ± 3. 27 days） and ventilator dependent time（ 4. 68 ± 3. 10 vs 6. 83 ± 3. 21 days） were significantly shorter in the experimental group than in the control group（ P 0. 05）. The levels of IL-6（ 62. 63 ±45. 25 vs 112. 38 ± 66. 23 ng/ml）,TNF-alpha（ 23. 62 ± 4. 27 vs 34. 82 ± 5. 29 ng/ml） and IL-1 beta（ 32. 52 ± 8. 32 vs 46. 15 ± 9. 52 ng/mL） and IL-10（ 295. 21 ± 106. 28 vs 361. 78 ± 102. 03 ng/ml） in the experimental group after treatment were significantly lower than in the control group（ P 0. 05）. Blood creatinine（ 61. 47 ± 10. 65 vs 79. 30 ± 11. 75 μmol/L） and blood urea nitrogen（ 8. 69 ± 3. 61 vs 14. 06 ± 3. 76mmol/L） were significantly reduced,vital signs were significantly improved,white blood cell count（ 11. 80± 4. 51 × 10^9/L vs 14. 53 ± 5. 09 × 10^9/L） and APACHE II score（ 11. 62 ± 3. 71 vs 14. 36 ± 3. 52） significantly increased,and the oxygenation index（ 362. 56 ± 98. 25 vs 82. 84 ± 105. 38） significantly decreased in the experimental group after treatment as compared with those in the control group（ P 0. 05）. Conclusions Continuous plasma filtration combined with plasma adsorption therapy can effectively reduce the level of inflammatory cytokines in patients with septic AKI,alleviate inflammation and improve the prognosis of patients.