连续性肾脏替代疗法与间歇性血液透析治疗老年重症肾衰竭的效果比较

Comparison of effects of continuous renal replacement therapy and intermittent hemodialysis in the treatment of severe renal failure in elderly patients

目的比较连续性肾脏替代疗法(CRRT)与间歇性血液透析(IHD)治疗老年重症肾衰竭患者的临床效果。方法随机对照研究。抽取2018年3月至2023年3月郑州市第九人民医院收治的58例老年重症肾衰竭患者为研究对象,按随机数字表法分为CRRT组与IHD组,每组29例。IHD组采用IHD治疗,CRRT组采用CRRT治疗。比较两组治疗总有效率,比较两组治疗前后肾功能(血肌酐、尿素氮、肌酐清除率)、炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、超敏C反应蛋白(hs-CRP)]水平、中心静脉压(CVP)、急性生理与慢性健康评分表Ⅱ(APACHEⅡ)评分。结果CRRT组总有效率(96.55%,28/29)高于IHD组(72.41%,21/29),P<0.05。治疗后,CRRT组血肌酐、尿素氮水平低于IHD组,肌酐清除率高于IHD组(P<0.05)。治疗后,CRRT组IL-6、CRP、hs-CRP水平低于IHD组(P<0.05)。治疗后,CRRT组CVP水平低于IHD组(P<0.05)。治疗后,CRRT组APACHEⅡ评分低于IHD组(P<0.05)。结论与IHD相比,CRRT治疗老年重症肾衰竭患者效果显著,可改善微炎症状态和血流动力学,减轻肾功能损害和病情严重程度。

Objective To compare the efficacy of continuous renal replacement therapy(CRRT)and intermittent hemodialysis(IHD)in the treatment of severe renal failure in elderly patients.Methods Fifty-eight elderly patients with severe renal failure admitted to the Ninth People’s Hospital of Zhengzhou from March 2018 to March 2023 were selected as the study subjects of the randomized controlled study.They were divided into the CRRT group and the IHD group using a random number table method,with 29 cases in each group.The IHD group was treated by IHD,while the CRRT group was treated by CRRT.The total effective rate of the two groups were compared.The renal function(blood creatinine,urea nitrogen,creatinine clearance rate),levels of inflammatory factors,including interleukin-6(IL-6),C-reactive protein(CRP)and hypersensitivity C-reactive protein(hs-CRP),central venous pressure(CVP),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were compared between the two groups before and after treatment.Results The total effective rate of the CRRT group(96.55%,28/29)was higher than that of the IHD group(72.41%,21/29),P<0.05.After treatment,the levels of serum creatinine and urea nitrogen in the CRRT group were lower than those in the IHD group,while the creatinine clearance rate was higher than that in the IHD group(P<0.05).After treatment,the levels of IL-6,CRP,and hs-CRP in the CRRT group were lower than those in the IHD group(P<0.05).After treatment,the level of CVP in the CRRT group was lower than that in the IHD group(P<0.05).After treatment,the APACHEⅡscore in the CRRT group was lower than that in the IHD group(P<0.05).Conclusions Compared with IHD,CRRT has a significant therapeutic effect on severe renal failure in elderly patients;it can alleviate the state of micro inflammation and hemodynamics,and reduce renal function damage and severity of the disease condition.