持续低效血液透析与连续性肾脏替代治疗在感染性休克急性肾损伤患者的疗效对比

Comparison of therapeutic effect between sustained low-efficiency dialysis and continuous renal replacement therapy in acute kidney injury patient with septic shock

目的对比研究持续低效血液透析(SLED)与连续性肾脏替代治疗(CRRT)在感染性休克急性肾损伤(AKI)患者中治疗效果。方法选择60例感染性休克AKI的患者,其中男性36例,女性24例;年龄28~71岁,平均年龄49.56岁。随机分为SLED组(30例)和CRRT组(30例)。两组患者均按《2016国际严重脓毒症及脓毒症休克诊疗指南》治疗,在此基础上分别予以SLED(每次治疗8~10 h,24 h后重复治疗,每例患者至少进行3次以上)和CRRT[模式为连续性静脉-静脉血液滤过,治疗剂量35~40 mL/(kg·h),初始24 h持续治疗,然后根据病情调整治疗时间]。分别观察两组患者治疗前后的血肌酐、pH、钾离子、每天液体平衡、急性生理与慢性健康评价Ⅱ(APACHEⅡ)评分及治疗期间血流动力学稳定性的变化。并比较两组患者的重症监护病房(ICU)住院时间、90 d病死率。结果与CRRT组比较,SLED组治疗后12 h和治疗后5 d的血肌酐、钾离子水平均显著低于CRRT组(P<0.05)。与CRRT组APACHEⅡ评分[(14.78±3.79)分]比较,SLED组治疗后5 d的APACHEⅡ评分[(10.45±3.02)分]明显低于CRRT组(P<0.05)。两组患者治疗期间,SLED组具有与CRRT组相近的血流动力学稳定性(P>0.05)。其中,SLED组血管加压药指数(VI)为20.32±5.18,血管加压药依赖性(VD)为(22.08±4.41)%;CRRT组VI为21.05±5.63,VD为(22.67±4.95)%。SLED组患者ICU住院时间[(15.32±3.65)d]显著短于CRRT组[(19.76±4.18)d],差异有统计学意义(P<0.05)。但两组患者90 d病死率差异无统计学意义(33.33%vs 36.67%;P>0.05)。结论SLED治疗感染性休克AKI患者的疗效确切,且在治疗期间血流动力学稳定性方面并不亚于CRRT。

Objective To compare therapeutic effect between sustained low-efficiency dialysis(SLED)and continuous renal replacement therapy(CRRT)in acute kidney injury(AKI)patient with septic shock.Methods A total of 60 AKI patients with septic shock were enrolled,which included 36 males and 24 females,aged 28-71 years old with mean age of 49.56 years old.All of them were randomly divided into SLED group(n=30)and CRRT group(n=30).Based on standardization treatment(Surviving Sepsis Campaign:International Guidelines for Management of Severe Sepsis and Septic Shock:2016),SLED group was given SLED treatment(treatment 8-10 hours,re-treatment after 24-hour,each patient at least 3 times)and CRRT group performed CRRT treatment[continuous veno venous hemodialysis,with treatment dose of 35-40 mL/(kg·h),initial treatment time for 24-hour,then adjusted treatment time according to illness state].The serum creatinine,pH,potassium,daily fluid balance,acute physiology and chronic health assessmentⅡ(APACHEⅡ)score and hemodynamic stability before and post treatment were observed.The hospitalization time of intensive care unit(ICU)and 90-day mortality were compared between 2 groups.Results Compared with CRRT group,the serum creatinine and potassium level at 12-hour and 5-day after treatment in SLED group was significantly lower than that in CRRT group(P<0.05).The APACHEⅡscore at 5-day after treatment in SLED group was significantly lower than that in CRRT group[(10.45±3.02)scores vs(14.78±3.79)scores;P<0.05].The SLED group had similar hemodynamic stability to CRRT group during treatment(P>0.05).The vasopressor index(VI,20.32±5.18)and vasopressor dependency[VD,(22.08±4.41)%]in SLED group were similar with VI(21.05±5.63)and VD[(22.67±4.95)%]in CRRT group.In SLED group,the hospitalization time of ICU were significantly shorter than that of CRRT group[(15.32±3.65)days vs(19.76±4.18)days,P<0.05].There was no significant difference in 90-day mortality between 2 groups(33.33%vs 36.67%;P>0.05).Conclusion It is demonstrated that SLED is effective in AKI patient with septic shock,and the hemodynamic stability in SLED was as well as CRRT during treatment.