心脏外科术后感染合并急性肾损伤患者采用oXiris滤器行连续性肾脏替代治疗的效果

Efficacy of oXiris filter in continuous renal replacement therapy on infection complicated with acute kidney injury after cardiac surgery

目的观察心脏外科术后感染合并急性肾损伤(AKI)患者采用oXiris滤器行连续性肾脏替代治疗(CRRT)的疗效,探讨其安全性。方法2023年1—12月新疆医科大学第一附属医院诊治心脏外科术后感染合并AKI患者7例,均于抗感染治疗同时应用oXiris滤器行CRRT,记录CRRT时间、CRRT期间并发症发生情况、ICU停留时间、住院时间及生存情况。比较CRRT上机前与CRRT撤机时左室射血分数、血红蛋白、血小板计数、N末端脑钠肽前体、总胆红素、血肌酐、血尿素、尿量、白细胞介素-6、降钙素原、凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、平均动脉压、多巴胺用量、去甲肾上腺素用量、血管活性药物评分、血乳酸、急性生理与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分。结果(1)7例CRRT时间为45(14,118)h,CRRT期间发生鼻腔出血、小肠出血各1例,滤器凝血撤机1例。7例CRRT撤机后转入普通病房继续抗感染治疗,2例死亡,5例存活出院,ICU停留时间17(10,34)d,住院时间38(16,54)d。(2)7例CRRT撤机时左室射血分数60.72%(60.09%,60.72%)、总胆红素[(128.94±42.68)μmol/L]均高于上机前[56.76%(55.12%,57.79%)、(83.57±27.02)μmol/L](Z>0.999,P=0.028;t=-2.463,P=0.049),N末端脑钠肽前体[(5190.86±4516.01)ng/L]、血肌酐[79.00(77.45,97.91)μmol/L]、血尿素[(10.49±5.69)mmol/L]、白细胞介素-6[219.00(117.00,281.00)ng/L]、血管活性药物评分[(14.71±6.71)分]、SOFA评分[(8.86±3.60)分]均低于上机前[(9417.14±6999.29)ng/L、176.82(146.44,229.79)μmol/L、(23.86±14.29)mmol/L、2660.00(2574.00,2985.00)ng/L、(30.14±11.46)分、(11.43±3.54)分](t=2.500、Z>0.999、t=2.833、Z>0.999、t=3.446、t=4.204,P均<0.05),去甲肾上腺素用量[(0.10±0.05)μg/(kg·min)]少于上机前[(0.24±0.11)μg/(kg·min)](t=3.571,P=0.012),凝血酶原时间[12.40(12.00,12.60)s]短于治疗前[13.00(12.60,13.30)s](Z=2.000,P=0.047),血红蛋白、血小板计数、降钙素原、活化部分凝血活酶时间、纤维蛋白原、血乳酸、多巴胺用量、平均动脉压、尿量、APACHE II评分与上机前比较差异均无统计学意义(P>0.05)。结论心脏外科术后感染合并AKI患者应用oXiris滤器行CRRT可有效清除血液循环中炎症介质,改善血流动力学及心、肾功能,益于容量管理。

Objective To observe the efficacy of continuous renal replacement therapy(CRRT)with oXiris filter on infection complicated with acute kidney injury(AKI)after cardiac surgery,and to investigate its safety.Methods Seven patients with infection complicated with AKI after cardiac surgery were diagnosed and treated in the First Affiliated Hospital of Xinjiang Medical University from January to December 2023.All patients were given anti-infective treatment and CRRT with oXiris filter.The length of CRRT,comorbidities,length of ICU stay,length of hospital stay and survival were recorded.The data were compared before CRRT was started and terminated including left ventricular ejection fraction,haemoglobin,platelet count,N-terminal pro-brain natriuretic peptide,total bilirubin,blood creatinine,blood urea,urine output,interleukin-6,procalcitanin,prothrombin time,fibrinogen,activated partial throm boplastin time,mean arterial pressure,dopamine dosage,norepinephrine dosage,vasoactive drug score,blood lactate,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)score,and Sequential Organ Failure Assessment(SOFA)score.Results(1)CRRT lasted for 45(14,118)h in 7 patients.Nasal bleeding occurred in 1 patient,small intestinal bleeding occurred in 1,and CRRT was terminated due to filter coagulation in 1.All 7 patients were transferred to the general ward after CRRT was terminated,among whom 2 died in hospital and 5 were discharged.The length of ICU stay was 17(10,34)d and the length of hospital stay was 38(16,54)d.(2)The left ventricular ejection fraction and total bilirubin were higher before CRRT was terminated[60.72%(60.09%,60,72%),(128.94±42.68)μmol/L]than those before CRRT was started[56.76%(55.12%,57.79%),(83.57±27.02)μmol/L](Z>0.999,P=0.028;t=-2.463,P=0.049).The levels of N-terminal pro-brain natriuretic peptide,blood creatinine,blood urea and interleukin-6,as well as vasoactive drug score and SOFA score were lower before CRRT was terminated[(5190.86±4516.01)ng/L,79.00(77.45,97.91)μmol/L,(10.49±5.69)mmol/L,219.00(117.00,281.00)ng/L,14.71±6.71,8.86±3.60]than those before CRRT was started[(9417.14±6999.29)ng/L,176.82(146.44,229.79)μmol/L,(23.86±14.29)mmol/L,2660.00(2574.00,2985.00)ng/L,30.14±11.46,11.43±3.54](t=2.500,Z>0.999,t=2.833,Z>0.999,t=3.446,t=4.204;all P values<0.05).The norepinephrine dosage was lower before CRRT was terminated[(0.10±0.05)μg/(kg·min)]than that before CRRT was started[(0.24±0.11)μg/(kg·min)](t=3.571,P=0.012).The prothrombin time was shorter before CRRT was terminated[12.40(12.00,12.60)s]than that before CRRT was started[13.00(12.60,13,30)s](Z=2,000,P=0.047).There were no significant differences in the haemoglobin,platelet count,procalcitonin,activated partial thromboplastin time,fibrinogen,blood lactate,dopamine usage,mean arterial pressure,urine output and APACHEⅡ score before CRRT was terminated compared with those before CRRT was started(P>0.05).Conclusion CRRT with oXiris filter benefits the volume management by effectively removing the inflammatory mediators from the blood,correcting haemodynamic parameters,and improving cardiac and renal function of patients with infection complicated with AKI after cardiac surgery.