连续性血液透析滤过治疗在老年急性肾损伤中的应用效果观察

Therapeutic effects of continuous hemodiafiltration on acute renal injury in the elderly

目的研究连续性血液透析滤过治疗在老年急性肾损伤中的应用效果。方法 2015年11月至2016年10月收治的老年急性肾损伤患者40例计算机随机分为2组,每组20例。分别实施普通血液透析治疗(对照组)和采用连续性血液透析滤过治疗(观察组)。对比2组的C-反应蛋白、血清尿素氮、肌酐水平、尿量恢复时间、器官支持时间、住院时间以及病死率。并在观察组中,按照置换液剂量分为低剂量组及高剂量组,观察置换液剂量对预后的影响。结果观察组老年急性肾损伤患者治疗后的C-反应蛋白、血清尿素氮、肌酐水平均优于对照组(P <0. 05),2组的尿量恢复时间、器官支持时间、住院时间进行比较存在高度差异(P <0. 05),对比病死率差别较小(P> 0. 05)。连续性血液透析滤过组置换液高剂量组及低剂量组患者经治疗后的预后情况无显著差异(P> 0. 05),但治疗后的老年急性肾损伤患者的血清尿素氮为(10. 14±3. 20) mmol/L、肌酐为(125. 48±31. 97) mmol/L,均比对照组低(P <0. 05),且治疗4 d的APACHEⅡ评分为(17. 85±6. 13)分,第7天的APACHEⅡ评分为(15. 25±7. 19)分,均低于对照组(P <0. 05)。结论老年急性肾损伤患者采用连续性血液透析滤过治疗的效果可观,其置换液剂量的控制对于预后情况无显著影响效果。

Objective To explore the therapeutic effects of continuous hemodiafiltration on acute renal injury in the elderly. Methods Forty elderly patients with acute renal injury who were admitted and treated in our hospital from November 2015 to October 2016 were randomly divided into control group （ n =20） and observation group （ n =20）. The patients in control group and observation group were treated by common hemodialysis and continuous veno-venous haemodiafiltration,respectively. The levels of C reactive protein, serum urea nitrogen and creatinine, urine recovery time, organ support time, length of stay and mortality rate were compared between the two groups. Moreover, the patients in observation group were subdivided into low-dose group and high-dose group to observe the effects of the dose on prognosis. Results The levels of C reactive protein, serum urea nitrogen and creatinine of the elderly patients with acute renal injury in observation group were superior to in control group （ P 〈0.05）. There were significant differences in the recovery time, organ support time and hospitalization time between the two groups （ P 〈0.05）,however,there was little difference in mortality between two groups （ P 〉 0.05）. Moreover, there was no significant difference in the prognosis after operation between low-dose group and high-dose group （ P 〉0.05）. After treatment, the serum level of urea nitrogen and creatinine in observation group were （10.14± 3.20 ）mmol/L and （125.48±31.97）mmol/L, respectively, which were significantly lower than those in control group （ P 〈 0.05 ）. In addition, the APACHE Ⅱ scores on days 4, 7 after treatment were （17.85±6.13） and（15.25±7.19）, respectively, which were significantly lower than those in control group （ P 〈0.05）. Conclusion The continuous hemodiafiltration is quite effective in treating acute renal injury in the elderly,moreover,the dose of displacement liquid has no significant effects on the prognosis of patients.