oXiris血液滤器在特重度烧伤合并脓毒症及急性肾损伤患者中的疗效观察

Observation on the efficacy of oXiris hemofilter in the treatment of severe burn complicated with sepsis and acute kidney injury

目的探讨oXiris血液滤器在特重度烧伤合并脓毒症及急性肾损伤中应用的疗效。方法回顾性分析2018年5月~2021年2月宁夏医科大学总医院血液透析中心使用oXiris血液滤器进行连续性静脉-静脉血液透析滤过(continuous venous-venous hemofiltration,CVVHDF)治疗的5例特重度烧伤合并脓毒症及急性肾损伤患者的临床资料。观察5例患者在使用oXiris血液滤器进行CVVHDF治疗前及治疗后24小时生命体征(体温、平均动脉压、心率、呼吸、尿量等)、血常规、血气分析及生化指标的变化情况,并对患者进行序贯器官衰竭评分(sequential organ failure assessment,SOFA)。结果患者使用oXiris血液滤器进行CVVHDF治疗后24小时的尿量(Z=-2.069,P=0.039)较治疗前增加,血小板(t=-3.977,P=0.001)较治疗前升高,血钠(t=2.652,P=0.016)、SOFA评分(t=4.265,P<0.001)较治疗前降低;体温(t=-0.258,P=0.799)、平均动脉压(t=0.168,P=0.868)、心率(t=1.057,P=0.304)、呼吸(t=0.481,P=0.636)、pH(t=1.304,P=0.208)、血清白细胞计数(t=-1.616,P=0.123)、血清胆红素(t=0.560,P=0.582)、血肌酐(t=0.755,P=0.459)等指标较治疗前无明显变化。5例患者28天生存率为60.00%。结论应用oXiris血液滤器进行CVVHDF治疗可以改善特重度烧伤合并脓毒症及急性肾损伤患者的凝血功能,增加尿量,降低SOFA评分。

Objective To explore the efficacy of oXiris hemofilter in the treatment of severe burn patients complicated with sepsis and acute kidney injury.Method The clinical data of 5 patients with severe burn complicated with sepsis and acute kidney injury treated with continuous venovenous hemofiltration(CVVHDF)with oXiris hemofiltration in the hemodialysis center of General Hospital of Ningxia Medical University from May 2018 to February 2021 were retrospectively analyzed.The changes in general vital signs(body temperature,MAP,heart rate,respiration,urine volume,etc.),blood routine,blood gas analysis,and biochemical indexes were observed in 5 patients before and 24 hours after CVVHDF treatment with oXiris hemofiltration,and the Sequential Organ Failure Assessment(SOFA)score was calculated respectively.Results①In the following 24 hours after CVVHDF with oXiris hemofiltration,compared with before treatment,the urine volume of 24 hours(Z=-2.069,P=0.039),the platelets count(t=-3.977,P=0.001)were increased,and the serum sodium level(t=2.652,P=0.016)and the SOFA score(t=4.265,P<0.001)was decreased.The indexes of body temperature(t=-0.258,P=0.799),MAP(t=0.168,P=0.868),heart rate(t=1.057,P=0.304),respiration(t=0.481,P=0.636),PH(t=1.304,P=0.208),WBC(t=-1.616,P=0.123),serum bilirubin(t=0.560,P=0.582),serum creatinine(t=0.755,P=0.459)were improved,but there was no significant difference before and after treatment.②The 28-day survival rate of these patients was 60%.Conclusions CVVHDF therapy with oXiris hemofiltration can improve coagulation function,promote the recovery of kidney function,reduce SOFA score in severe burn patients complicated by sepsis and acute kidney injury.