连续性血液净化治疗对恶性肿瘤合并急性肾损伤患者肾功能及血流动力学指标的影响

Effect of continuous blood purification treatment on renal function and hemodynamic indicators in patients with malignant tumor complicated with acute kidney injury

目的探讨连续性血液净化(CBP)治疗对恶性肿瘤合并急性肾损伤(AKI)患者肾功能及血流动力学指标的影响。方法根据治疗方式的不同将78例恶性肿瘤合并AKI患者分为对照组(n=37)和观察组(n=41)。对照组患者采用常规间歇性血液透析(IHD)治疗,每周3~4次,连续治疗3个月;观察组患者采用CBP治疗,每2天1次,连续治疗3个月。比较两组患者的疗效、肾功能指标[血尿素氮(BUN)和血肌酐(Scr)]、血流动力学指标[心排血量(CO)、心率(HR)、平均动脉压(MAP)]及预后[急性生理学和慢性健康状况评分(APACHEⅡ)和治疗后1年死亡率]。结果治疗后,观察组患者的总有效率高于对照组(P﹤0.05)。治疗后,两组患者的血清BUN、Scr水平均低于本组治疗前,且观察组患者的血清BUN、Scr水平均低于对照组,差异均有统计学意义(P﹤0.05)。治疗后,观察组患者的CO、MAP均低于对照组,HR高于对照组,差异均有统计学意义(P﹤0.05)。治疗后,观察组患者的APACHEⅡ评分和1年死亡率均低于对照组(P﹤0.05)。结论CBP治疗能够改善恶性肿瘤合并AKI患者的肾功能及血流动力学指标,提高治疗总有效率和患者预后。

Objective To investigate the effect of continuous blood purification(CBP)treatment on renal function and hemodynamic indicators in patients with malignant tumor complicated with acute kidney injury(AKI).Method A total of 78 patients with malignant tumors combined with AKI were divided into control group(n=37)and observation group(n=41)according to different treatment methods.The patients in the control group were treated with routine intermittent hemodialysis(IHD),3-4 times per week,for 3 months.The patients in the observation group were treated with CBP,once every two days,for 3 months.The effect,renal function indicators[blood urea nitrogen(BUN)and serum creatinine(Scr)],hemodynamic indicators[cardiac output(CO),heart rate(HR),mean arterial pressure(MAP)],and prognosis[acute physiology and chronic health evaluation II(APACHE II)and postoperative 1-year mortality]were compared between the two groups.Result After the treatment,the total response rate of patients in the observation group was higher than that in the control group(P<0.05).After the treatment,the serum BUN and Scr levels of the two groups were lower than those before the treatment,and the serum BUN and Scr levels of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).After the treatment,the CO and MAP of the observation group were lower than those of the control group,and the HR was higher than that of the control group,the differences were statistically significant(P<0.05).After the treatment,the APACHE II score and 1-year mortality of the observation group were lower than those of the control group(P<0.05).Conclusion CBP therapy can improve the renal function and hemodynamic indicators of patients with malignant tumor complicated with AKI,and improve patients’total response rate and prognosis.