不同连续性肾脏替代治疗模式对脓毒症急性肾损伤患者溶质清除效果的比较

Effect of different continuous renal replacement therapy on solute removal in patients with sepsis-induced acute renal injury

目的通过对不同连续性肾脏代替治疗(CRRT)模式的研究,探究其对患有脓毒症合并急性肾损伤的患者溶质清除的影响。方法选取2016年1月至2018年5月确诊为脓毒症合并急性肾损伤的患者80例。按随机数字表法分为A、B两组,各40例。两组患者处方废液计剂量(Kp)均为50 ml·kg-1·h-1,都使用百分百前稀释。A组患者采用连续静脉-静脉血液滤过(CVVH),B组采用连续静脉-静脉血液透析滤过(CVVHDF),且流速与透析液流速相同。观察记录不同模式下处方CRRT时间、实际CRRT时间、机械通气时间、ICU住院时间、总住院时间、48 d病死率。并计算CRRT的剂量,包含支付剂量(Kd)、Kp、校正剂量(Kpc)、实际溶质清除剂量(K)。结果两组Kp比较差异无统计学意义(P> 0. 05); A组Kpc、Kd、KCr小于B组(P <0. 01)。两组患者组内Kp、Kpc、Kd、KCr之间比较差异均有统计学意义(P <0. 01)。治疗转归后,不同模式下处方CRRT时间、实际CRRT时间、机械通气时间、ICU住院时间、总住院时间、48 d病死率比较无统计学差异(P> 0. 05)。结论不同CRRT模式下,连续性肾脏代替剂量过多;在Kp相同的情况下,不同CRRT模式都能很好的清除炎症因子,且预后相当。其中CVVHDF对小分子溶质的清除效果优于CVVH。

objective To explore the effects of different continuous renal replacement therapy( CRRT) models on solute clearance in patients with acute renal injury associated with sepsis. Methods A total of 80 patients with sepsis-induced acute renal injury confirmed from January 2016 to May 2018 were selected and randomly divided into group A and group B( n = 40,each). The same prescription liquid dose( Kp) in both groups( 50 ml·kg-1·h-1,with 100 % pre-dilution method). With the same flow rate,continuous venous-venous hemofiltration( CVVH) was performed in group A,and continuous venous-venous hemodialysis filtration( CVVHDF) was performed in group B. The prescription CRRT time,actual CRRT time,mechanical ventilation time,ICU hospitalization time,total hospital stay and 48-day mortality were observed and recorded under different modes. The dose of CRRT was calculated,including paid dose( Kd) and Kp,corrected dose( Kpc),and actual solute clearance dose( K). Results There was no statistical difference in Kp between two groups( P > 0. 05). Kpc,Kd and KCrin group A were significantly lower than those in group B( P < 0. 01). There were significant differences in Kp,Kpc,Kd and KCrbetween two groups( P < 0. 01). After treatment,there were no significant differences in CRRT time,actual CRRT time,mechanical ventilation time,ICU hospitalization time,total hospital stay and48-day mortality under different modes( all P > 0. 05). Conclusions Under different CRRT modes,the continuous renal replacement dose is too much;under the same prescription liquid dose,different CRRT modes can eliminate inflammatory factors effectively,and there is no significant difference in patients’ condition after treatment. The clearance rate of CVVH for small molecule solutes by CVVH is lower than that by CVVHDF.