吸附型连续性肾脏替代治疗滤器在脓毒症休克合并急性肾损伤患者中的应用

Application of endotoxin adsorption hemofilter continuous renal replacement therapy in septic shock patients with acute kidney injury

目的探讨在脓毒症休克合并急性肾损伤(acute kidney injury,AKI)患者中使用吸附型oXiris滤器进行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的临床效果。方法纳入20例怀疑革兰阴性菌感染脓毒症休克合并AKI的患者,使用oXiris滤器进行CRRT治疗48h。选择前期使用常规滤器进行CRRT治疗的25例同等类型的患者作为对照组。比较2组患者在CRRT治疗过程中血浆炎症因子和器官功能指标的变化情况。结果oXiris组患者升压药物使用时间、CRRT支持时间明显缩短(t/χ^(2)值分别为3.322,2.386;P值分别为0.004、0.022)。但2组患者ICU住院时间、总住院时间以及住院死亡率没有差异(t/χ^(2)值分别为1.649,0.821,0.627;P值分别为0.225,0.402,0.428)。与对照组相比,CRRT治疗48h后,oXiris组去甲肾上腺素剂量、血乳酸、SOFA评分和血浆白细胞介素(interleukin,IL)-6、IL-8及肿瘤坏死因子α水平明显降低(t/χ^(2)值分别为2.347,2.624,3.864,3.464,2.670,2.479;P值分别为0.018,0.015,0.004,0.003,0.015,0.023)。结论对于脓毒症性AKI的患者,使用oXiris滤器进行CRRT治疗可以更加有效地清除患者体内的炎症因子水平,改善患者的器官功能评分。

Objective To evaluate the effect of endotoxin adsorption haemofilter continuous renal replacement therapy(CRRT)in patients with septic shock complicated with acute kidney injury(AKI).Methods 20 patients suspected gram-negative septic shock with AKI and treated with CRRT using oXiris filter for 48h were enrolled.25 patients with the same diagnosis treated with CRRT using regular filter in our center were selected as the control group.The changes of organ function indicators and plasma inflammatory factors in the two groups during the treatment period were observed.Results Compared with the control group,the dosage of norepinephrine,plasma lactate,plasma inflammatory factors levels and the sequential organ failure assessment(SOFA)scores were significantly lower in oXiris group after 48 hours CRRT(P<0.05).Meanwhile,the whole duration of using vasoactive drugs and CRRT in oXiris group was significantly shorter than controls(P=0.004,P=0.022).But there were no differences in length of hospital and intensive care unit(ICU)stays and mortality between groups.Conclusions Compared with conventional haemofilter,CRRT with oXiris haemofilter is more effective in removing plasma inflammatory factors and improving organ function in patients with septic shock complicated with AKI.