血液灌流联合CHVHF治疗脓毒血症并急性肾损伤患者的疗效分析

Efficacy analysis of hemoperfusion combined with CHVHF in patients with sepsis and acute kidney injury

目的 分析脓毒血症并急性肾损伤(AKI)患者使用血液灌流联合连续性高容量血液滤过(CHVHF)治疗的疗效。方法 60例脓毒血症并AKI患者为研究对象,采用随机数字表法分为对照组与观察组,每组30例。对照组在常规抗脓毒血症治疗基础上予以CHVHF治疗,观察组在对照组基础上增加血液灌流治疗。比较两组治疗前和治疗后1、2、3、7 d的急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官衰竭估计(SOFA)评分,治疗前、治疗后7 d的血压[收缩压(SBP)、舒张压(SDP)]、血pH值及碱性磷酸酶(ALP),治疗前后肾动脉指数(RRI),治疗后彩色多普勒血流现显像(RCDFI)血流分级及治疗28 d全因死亡率。结果 治疗后2、3、7 d,观察组APACHEⅡ评分分别为(16.33±2.17)、(11.15±2.16)、(9.17±2.26)分, SOFA评分分别为(7.02±2.69)、(6.08±2.64)、(5.58±1.67)分;对照组APACHEⅡ评分分别为(18.39±2.47)、(13.02±0.71)、(11.59±0.88)分, SOFA评分分别为(8.95±2.61)、(7.97±2.69)、(6.98±1.51)分。治疗后2、3、7 d,两组APACHEⅡ评分及SOFA评分均明显低于本组治疗前及治疗后1 d,且观察组APACHEⅡ评分及SOFA评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后7 d,观察组SBP、DBP、血pH值及ALP分别为(136.24±2.18)mm Hg(1 mm Hg=0.133 kPa)、(86.29±1.84)mm Hg、(7.43±0.21)、(66.36±2.84)U/L,对照组分别为(129.63±2.39)mm Hg、(80.24±1.59)mm Hg、(7.31±0.24)、(105.26±5.28)U/L;观察组SBP、DBP、血p H值均高于对照组, ALP低于对照组,差异有统计学意义(P<0.05)。治疗后7 d,观察组RRI(0.65±0.09)低于对照组的(0.71±0.08),差异有统计学意义(P<0.05)。治疗后,对照组RCDFI血流分级0、1、2、3级分别为7、10、7、6例,观察组分别为2、5、12、11例。观察组RCDFI血流分级优于对照组,差异有统计学意义(P<0.05)。观察组28 d全因死亡率为3.33%(1/30),低于对照组的20.00%(6/30),差异有统计学意义(P<0.05)。结论 临床对脓毒血症并AKI患者实施血液灌流联合CHVHF治疗取得满意效果,可提升患者血压值,减少ALP值,改善APACHEⅡ评分及SOFA评分,降低RRI,提升RCDFI血流分级,值得临床推广和应用。

Objective To analyze the efficacy of hemoperfusion combined with continuous high-volume hemofiltration(CHVHF) in patients with sepsis and acute kidney injury(AKI). Methods A total of 60 patients with sepsis and AKI were studied, and were divided into a control group and an observation group according to the random numerical table, with 30 cases in each group. The control group was treated with CHVHF on the basis of conventional anti-septic treatment, while the observation group was treated with additional hemoperfusion on the basis of the control group. Both groups were compared in terms of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) scores and sequential organ failure assessment(SOFA) score before treatment, 1, 2, 3 and 7 d after treatment, blood pressure [systolic blood pressure(SBP), diastolic blood pressure(SDP)], blood pH and alkaline phosphatase(ALP) before and 7 d after treatment, renal resistive index(RRI) before and after treatment, renal color Doppler flow imaging(RCDFI) blood flow grading and all-cause mortality at 28 d after treatment. Results At 1, 2, 3 and 7 d after treatment, in the observation group, the APACHEⅡ scores were(16.33±2.17),(11.15±2.16),(9.17±2.26) points, and the SOFA scores were(7.02±2.69),(6.08±2.64) and(5.58±1.67) points;in the control group, the APACHEⅡ scores were(18.39±2.47),(13.02±0.71), and(11.59±0.88) points, and the SOFA scores were(8.95±2.61),(7.97±2.69), and(6.98±1.51) points. The APACHEⅡ score and SOFA scores in both groups were significantly lower than those before treatment and 1 d after treatment in this group,and the APACHEⅡ score and SOFA score in the observation group were significantly lower than those in the control group, and the differences were statistically significant(P<0.05). At 7 d after treatment, the SBP, DBP,blood pH and ALP were(136.24±2.18) mm Hg(1 mm Hg=0.133 kPa),(86.29±1.84) mm Hg,(7.43±0.21) and(66.36±2.84) U/L in the observation group, and(129.63±2.39) mm Hg,(80.24±1.59) mm Hg,(7.31±0.24)and(105.26±5.28) U/L in the control group. The SBP, DBP, and blood pH in the observation group were higher than those in the control group, and ALP was lower than that in the control group, and the differences were statistically significant(P<0.05). At 7 d after treatment, the RRI(0.65±0.09) of the observation group was lower than(0.71±0.08) of the control group, and the difference was statistically significant(P<0.05). After treatment,there were 7 cases of RCDFI blood flow grade 0, 10 cases of grade 1, 7 cases of grade 2 and 6 cases of grade 3 in the control group;in the observation group, there were 2 cases of blood flow grade 0, 5 cases of grade 1, 12 cases of grade 2, and 11 cases of grade 3. The RCDFI blood flow grading in the observation group was better than that in the control group, and the difference was statistically significant(P<0.05). The 28-d all-cause mortality rate in the observation group was 3.33%(1/30), which was lower than 20.00%(6/30) in the control group of, and the difference was statistically significant(P<0.05). Conclusion Hemoperfusion combined with CHVHF can achieve satisfactory results in patients with sepsis and AKI. This method can improve the blood pressure of patients, reduce the ALP value, improve the APACHEⅡ score and SOFA score, reduce the RRI value and improve the RCDFI blood flow grading, which is worthy of further promotion and application in clinical practice.