局部枸橼酸钠抗凝在重症急性肾损伤患者连续性肾脏替代疗法中的应用效果及对炎症的影响

Effect of regional citrate anticoagulation in the continuous renal replacement therapy of patients with severe acute kidney injury and the impact on inflammatory

目的观察局部枸橼酸钠抗凝(RCA)在重症急性肾损伤(AKI)患者连续性肾脏替代疗法(CRRT)中的应用效果及其对机体炎症的影响。方法选取2020年12月—2022年2月临沂市中心医院收治的50例经CRRT+低分子肝素治疗的重症AKI患者作为对照组,另选取本院同期经CRRT+RCA治疗的50例重症AKI患者作为研究组。比较2组临床疗效,透析前、透析24 h后炎性因子[血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平及白细胞计数(WBC)]、肾功能指标[血清尿素氮(BUN)、血肌酐(SCr)及24 h尿微量白蛋白(mAlb)]及不良反应发生率。结果研究组总有效率为90.00%,高于对照组的72.00%(χ^(2)=5.263,P=0.022)。透析24 h后,2组血清IL-6、TNF-α、CRP、BUN、SCr水平及WBC、24 h尿mAlb低于透析前,且研究组低于对照组(P<0.05或P<0.01)。研究组用药期间不良反应总发生率(10.00%)与对照组(14.00%)比较,差异无统计学意义(χ^(2)=0.379,P=0.538)。结论RCA用于重症AKI患者CRRT治疗中可增强疗效,减轻机体炎症,改善肾功能,且不增加不良反应。

Objective To investigate the effect of regional citrate anticoagulation(RCA)in the continuous renal replacement therapy(CRRT)of patients with severe acute kidney injury(AKI)and the impact on inflammatory.Methods A total of 50 patients with severe AKI treated by CRRT+low molecular weight heparin from December 2020 to February 2022 in Linyi Central Hospital were selected as the control group,a total of 50 patients with severe AKI treated by CRRT+RCA in the hospital during the same period were selected as the study group.Clinical effect,inflammation factors(IL-6,TNF-α,CRP,WBC),renal function indexes(BUN,SCr,24 h urinary mAlb)before and after 24 hours of dialysis,and incidence of adverse reactions were compared between the two groups.Results The total effective rate of the study group(90.00%)was higher than control group(72.00%)(χ^(2)=5.263,P=0.022).After 24 hours of dialysis,serum levels of IL-6,TNF-α,CRP,BUN,SCr and WBC,24 h urinary mAlb of the two groups were lower than those before dialysis,and those indexes of the study group were lower than control group(P<0.05 or P<0.01).There was no significant difference in the incidence of adverse reactions between the study group(10.00%)and the control group(14.00%)(χ^(2)=0.379,P=0.538).Conclusion RCA applied to CRRT in the treatment of severe AKI patients can enhance the curative effect,effectively reduce the body′s inflammatory,improve renal function,and without increasing adverse reactions.