摘要
目的探讨持续性静脉-静脉血液滤过(CVVH)和持续性静脉-静脉血液透析滤过(CVVHDF)对脓毒症并发急性肾损伤(AKI)患者不同溶质清除能力的影响。方法回顾性分析2021年4月至2022年4月该院重症监护室收治的69例进行持续性肾脏替代治疗(CRRT)的脓毒症并发AKI患者的临床资料。根据不同滤过方式分为CVVH组(35例)和CVVHDF组(34例)。统计所有患者的预后情况,比较两组患者的临床资料、治疗前后的实验室指标及不同溶质的清除率。结果治疗30 d后,CVVH组7例患者死于脓毒症引起的多器官功能衰竭,2例患者死于心力衰竭,4例患者需继续进行CRRT,3例患者肾功能部分恢复。CVVHDF组6例患者死于脓毒症引起的多器官功能衰竭,3例患者死于心力衰竭,3例患者需继续进行CRRT,4例患者肾功能部分恢复。其余患者肾功能完全恢复并转回普通病房。CVVH组超滤速度、输注泵流速均快于CVVHDF组,差异均有统计学意义(P<0.05)。两组治疗前后预估肾小球滤过率、白细胞计数、C反应蛋白、肌酐、血尿素氮水平比较,差异均无统计学意义(P>0.05)。CVVH组肌酐清除率低于CVVHDF组,白细胞介素(IL)-8、IL-6清除率均高于CVVHDF组,差异均有统计学意义(P<0.05)。结论CVVHDF对肌酐的清除能力强于CVVH,而对IL-8、IL-6的清除能力弱于CVVH。
Objective To investigate the effects of continuous veno-venous hemofiltration(CVVH)and continuous veno-venous hemodiafiltration(CVVHDF)on different solutes clearance in patients with sepsis complicated with acute kidney injury(AKI).Methods The clinical data of 69 patients with sepsis complicated with AKI treated with continuous renal replacement therapy(CRRT)admitted to the intensive care unit of this hospital from April 2021 to April 2022 were retrospectively analyzed.The patients were divided into CVVH group(35 cases)and CVVHDF group(34 cases)according to different filtration methods.The prognosis of all patients was counted and the clinical data,laboratory indexes before and after treatment and clearance rates of different solutes were compared between the two groups.Results After 30 days of treatment,in CVVH group,7 patients died of multiple organ failure caused by sepsis,2 patients died of heart failure,4 patients still needed CRRT and 3 patients had partial recovery of renal function.In the CVVHDF group,6 patients died of multiple organ failure caused by sepsis,3 patients died of heart failure,3 patients still needed CRRT and 4 patients had partial recovery of renal function.The remaining patients had complete renal function recovery and were transferred back to the general ward.The ultrafiltration speed and the flow rate of infusion pump in CVVH group were faster than those in CVVHDF group,and the differences were statistically significant(P<0.05).There was no significant difference in estimated glomerular filtration rate,white blood cell count,the levels of C-reactive protein,creatinine and blood urea nitrogen between the two groups before and after treatment(P>0.05).The creatinine clearance rate in CVVH group was lower than that in CVVHDF group,and the clearance rates of interleukin(IL)-8 and IL-6 were higher than those in CVVHDF group,and the differences were statistically significant(P<0.05).Conclusion CVVHDF is superior to CVVH in the clearance of creatinine,but inferior to CVVH in the clearance of IL-8 and IL-6.
作者
姚成成
YAO Chengcheng(Department of Emergency Medicine,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou,Zhejiang 320000,China)
出处
《检验医学与临床》
CAS
2024年第8期1137-1140,1144,共5页
Laboratory Medicine and Clinic
