CVVH联合CRRT对脓毒血症伴急性肾功能衰竭患者肾功能损伤的修复作用

Repair effect of CVVH combined with CRRT on renal function damage in patients with sepsis and acute renal failure

目的观察持续静脉血液滤过(CVVH)联合连续性肾脏替代治疗(CRRT)对脓毒血症伴急性肾功能衰竭患者肾功能损伤的修复作用。方法选取2018年7月—2019年7月福建医科大学附属协和医院急诊内科收治脓毒血症伴急性肾功能衰竭患者114例,按照随机数字表法分为CRRT组与联合治疗组,每组57例。CRRT组行CRRT,联合治疗组行CRRT联合CVVH治疗。比较2组治疗前后平均动脉压(MAP)、多巴胺用量、氧合指数(PaO_(2)/FiO_(2)),β2-微球蛋白(β2-MG)、乳酸(LA)、内皮素(ET)、高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平,钾、钠、氯浓度和血肌酐(SCr)、尿素氮(BUN)浓度、排尿量,以及治疗总有效率。结果联合治疗组治疗总有效率高于CRRT组(89.47%vs.73.68%,χ^(2)/P=4.728/0.030);与CRRT组比较,治疗后联合治疗组MAP、PaO_(2)/FiO_(2)水平升高,多巴胺用量减少(t/P=8.301/0.001、4.903/0.001、2.984/0.001),联合治疗组β_(2)-MG、ET指标较低(t/P=22.570/0.001、25.110/0.001),LA高于CRRT组(t/P=5.143/0.001);联合治疗组hs-CRP、IL-6、TNF-α水平及钾、钠、氯浓度,SCr、BUN浓度均低于CRRT组(t/P=203.800/0.001、10.690/0.001、11.630/0.001,9.788/0.001、6.833/0.001、10.360/0.001,7.483/0.001、9.752/0.001),而排尿量高于CRRT组(t/P=4.621/0.001)。结论CVVH联合CRRT对脓毒血症伴急性肾功能衰竭患者进行治疗,可降低脓毒症风险,有效改善患者体内毒素,降低炎性反应程度,改善电解质平衡,促进肾功能损伤修复,治疗效果显著。

Objective To observe the repair effect of continuous venous hemofiltration(CVVH)combined with continuous renal replacement therapy(CRRT)on renal damage in patients with sepsis and acute renal failure.Methods From July 2018 to July 2019,114 patients with sepsis and acute renal failure were admitted to the Department of Emergency Medicine,Union Hospital of Fujian Medical University,and were divided into CRRT group and combination treatment group according to the random number table,with 57 cases in each group.CRRT group received CRRT,combined treatment group received CRRT combined CVVH treatment.Compare the MAP,dopamine dosage,PaO_(2)/FiO_(2),β2-MG,LA,ET,hs-CRP,IL-6,TNF-αlevels,potassium,sodium,chloride concentration and Cr,BUN concentration,urine output,and total effective rate of treatment before and after treatment in the two groups.Results The total effective rate of treatment in the combination therapy group was higher than that in the CRRT group(89.47%vs.73.68%,χ^(2)/P=4.728/0.030).Compared with the CRRT group,the combined treatment group increased the levels of MAP,PaO2/FiO2,and reduced the dosage of dopamine(t/P=8.301/0.001,4.903/0.001,2.984/0.001),and the combined treatment group had lowerβ_(2)-MG and ET indexes(t/P=22.570/0.001,25.110/0.001),LA was higher than CRRT group(t/P=5.143/0.001).The levels of hs-CRP,IL-6,TNF-αand the concentrations of potassium,sodium,and chlorine,Cr and BUN in the combined treatment group were lower than those in the CRRT group(t/P=203.800/0.001,10.690/0.001,11.630/0.001,9.788/0.001,6.833/0.001,10.360/0.001,7.483/0.001,9.752/0.001),and urine output was higher than the CRRT group(t/P=4.621/0.001).Conclusion CVVH combined with CRRT for the treatment of patients with sepsis and acute renal failure can reduce the risk of sepsis,effectively improve toxins in the patient,reduce the degree of inflammatory response,improve electrolyte balance,and promote the repair of renal damage.The treatment effect is significant.