早期脉冲式高容量血液滤过结合局部枸橼酸抗凝治疗脓毒症急性肾损伤

Efficacy of early pulsed high volume hemofiltration combined with local citrate anticoagulation in treatment of acute kidney injury in sepsis

目的探讨早期脉冲式高容量血液滤过结合局部枸橼酸抗凝治疗脓毒症急性肾损伤。方法回顾性分析2017年9月~2019年12月本院收治的86例脓毒症急性肾损伤患者,将行全身肝素抗凝连续静-静脉血液滤过(CVVH)治疗的患者设为对照组,将行局部枸橼酸抗凝脉冲式高容量血液滤过(PHVHF)治疗的患者设为观察组,每组各43例,比较两组治疗前和治疗72h后APACHEⅡ评分、肾功能、凝血功能、血流动力学及外周血炎症因子水平的变化,并记录不良反应及28d病死率。结果与治疗前比较,两组治疗72h后肾功能指标[血肌酐(SCr)、尿素氮(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]、血清炎性因子[降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6))]、中心静脉压(CVP)、APACHEⅡ评分、血小板计数(PLT)明显降低,而平均动脉压(MAP)、氧合指数、活化部分凝血时间(APTT)、凝血酶原时间(PT)明显增高(P<0.05),且治疗后上述指标组间比较差异有统计学意义(P<0.05);与对照组比较,观察组出血事件发生率、28d病死率均明显降低(均P<0.05)。结论早期PHVHF结合局部枸橼酸抗凝能提高炎性因子清除效果,改善肾功能,提高患者生存率,是一种较安全有效的脓毒症急性肾损伤临床治疗方法。

Objective To explore the effect of early pulsed high-volume hemofiltration combined with local citrate anticoagulation in the treatment of acute kidney injury in sepsis.Methods The clinical data of 86 patients with sepsis acute kidney injury treated in our hospital from September 2017 to December 2019 were retrospectively analyzed.The patients treated with whole body heparin anticoagulation continuous veno venous hemofiltration(CVVH)were set as the control group,and the patients treated with local citrate anticoagulation pulsed high volume hemofiltration(phvhf)were set as the observation group,with 43 cases in each group The changes of ApacheⅡscore,renal function,coagulation function,hemodynamics and inflammatory factors in peripheral blood were observed 72 hours after treatment.The adverse reactions and 28 day mortality were recorded.Results Compared with before treatment,renal function indexes[SCR,bun,NGAL],serum inflammatory factors[PCT,TNF-α,IL-6],central venous pressure(CVP),ApacheⅡscore,platelet count(PLT)]of the two groups after 72 hours of treatment were significantly higher than those before treatment The mean arterial pressure(map),oxygenation index(OI),activated partial coagulation time(APTT)and prothrombin time(PT)increased significantly(P<0.05).There were significant differences in the above indexes between the two groups after treatment(P<0.05).Compared with the control group,the incidence of bleeding events and 28 day mortality in the observation group were significantly lower(all P<0.05).Conclusion Early PHVHF combined with local citrate anticoagulation can improve the clearance of inflammatory factors,renal function,and the survival rate of patients.It is a safe and effective clinical treatment method for acute kidney injury in sepsis.