血液灌流联合连续性血液滤过治疗脓毒血症急性肾损伤的临床疗效

Clinical efficacy of hemoperfusion combined with continuous venous-venous hemofiltration in the treatment of sepsis-associated acute kidney injury

目的探讨血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)治疗脓毒血症急性肾损伤(AKI)的临床疗效及对患者炎症因子和血流动力学指标的影响。方法选取2020年3月—2023年3月首都医科大学附属北京世纪坛医院收治的98例脓毒血症AKI患者,根据治疗方式不同分为对照组(48例)与研究组(50例)。对照组患者采用CVVH治疗,研究组患者采用HP联合CVVH治疗。采用急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评估临床疗效,同时检测2组患者血清尿素氮(BUN)、血肌酐(Scr)、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)水平,监测患者心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),并统计2组患者不良反应发生情况。结果治疗前,2组患者APACHEⅡ评分比较,差异无统计学意义(P>0.05);治疗后,研究组APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05)。治疗前,2组患者血清BUN、Scr水平及日尿量比较,差异均无统计学意义(P>0.05);治疗后,研究组患者血清BUN、Scr水平均低于对照组,日尿量高于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者血清PCT及hs-CRP水平比较,差异均无统计学意义(P>0.05);治疗后,研究组患者血清PCT及hs-CRP水平均低于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者HR、MAP及CVP水平比较,差异均无统计学意义(P>0.05);治疗后,研究组患者HR低于对照组,MAP及CVP水平均高于对照组,差异均有统计学意义(P<0.05)。研究组与对照组患者不良反应发生率分别为4.00%(2/50)和10.42%(5/48),差异无统计学意义(χ^(2)=0.707,P=0.401)。结论HP联合CVVH治疗脓毒血症AKI,能有效降低患者炎症因子水平,调节血流动力学指标水平,改善患者肾功能,且安全性良好。

Objective This study aimed to investigate the clinical efficacy of hemoperfusion(HP)combined with continuous venous-venous hemofiltration(CVVH)in the treatment of sepsis-associated acute kidney injury(AKI),as well as its impact on inflammatory factors and hemodynamic parameters in patients.Methods A total of 98 patients with sepsis-associated AKI admitted to Beijing Shijitan Hospital,Capital Medical University from March 2020 to March 2023 were selected and allocated to a control group(n=48)and a study group(n=50)according to different treatment methods.The control group received CVVH treatment,while the study group received HP combined with CVVH treatment.The Acute Physiology and Chronic Health Evaluation II(APACHE II)scoring system was used to assess clinical efficacy.Serum levels of blood urea nitrogen(BUN),serum creatinine(Scr),procalcitonin(PCT),and high-sensitivity C-reactive protein(hs-CRP)were measured in both groups.Heart rate(HR),mean arterial pressure(MAP),and central venous pressure(CVP)were monitored,and adverse reactions in both groups were recorded.Results Before treatment,no significant difference was observed in APACHE II scores between the two groups(P>0.05).After treatment,the APACHE II score in the study group was significantly lower than that in the control group(P<0.05).Before treatment,no significant differences were found in serum BUN,Scr levels,and urine output between the two groups(P>0.05).After treatment,the serum BUN and Scr levels in the study group were lower than those in the control group,and the daily urine output was higher than that in the control group,with statistically significant differences(P<0.05).Before treatment,no significant differences were found in serum PCT and hs-CRP levels between the two groups(P>0.05).After treatment,the serum PCT and hs-CRP levels in the study group were significantly lower than those in the control group(P<0.05).Before treatment,no significant differences were noted in HR,MAP,and CVP levels between the two groups(P>0.05).After treatment,the HR in the study group was significantly lower than that in the control group,and the MAP and CVP levels were significantly higher than those in the control group(P<0.05).The difference in the incidence of adverse reactions between the study group and the control group was not statistically significant[4.00%(2/50)vs.10.42%(5/48);χ^(2)=0.707,P=0.401].Conclusion HP combined with CVVH treatment for sepsis-associated AKI can effectively reduce the levels of inflammatory factors,regulate hemodynamic parameters,and promote renal function,with a good safety profile.