不同连续性肾脏替代治疗模式及其剂量对脓毒症合并急性肾损伤患者溶质清除效果的研究

发布时间：2018-04-29 02:00

本文选题：肾替代疗法 + 脓毒症　；参考：《中国全科医学》2016年18期

【摘要】：目的观察不同连续性肾脏替代治疗(CRRT)模式及其剂量对脓毒症合并急性肾损伤(AKI)患者的溶质清除效果。方法选取2013年12月—2014年12月河北医科大学第四医院重症医学科(ICU)收治的符合纳入与排除标准的脓毒症合并AKI患者23例为研究对象。采用随机数字表法将患者分为连续性静脉-静脉血液滤过(CVVH)组(14例)和连续性静脉-静脉血液透析滤过(CVVHDF)组(9例)。两组均使用100%前稀释,处方废液剂量(K_p)设置为40.00 ml·kg~(-1)·h~(-1),其中CVVHDF组置换液流速与透析液流速相同。抗凝方案的选择依据患者凝血功能由临床医师决定。收集患者一般资料,计算CRRT剂量〔包括K_p、校正剂量(K_(pc))、交付剂量(K_d)、实际溶质清除剂量(K)〕。记录患者处方CRRT时间、实际CRRT时间、机械通气时间、住ICU时间、总住院时间、28 d病死率。结果两组患者Kp比较,差异无统计学意义(P0.05);CVVHDF组患者K_(pc)、K_d、K_(Cr)大于CVVH组(P0.05)。CVVH组、CVVHDF组患者K_(pc)、Kd、KCr小于K_p,K_d、K_(Cr)小于K_(pc),K_(Cr)小于K_d(P0.05)。CVVHDF组患者Kβ2-M、KIL-6、KIL-8小于CVVH组(P0.05)。两组患者处方CRRT时间、实际CRRT时间、机械通气时间、住ICU时间、总住院时间、28 d病死率比较,差异无统计学意义(P0.05)。结论不同CRRT模式下CRRT剂量均被高估;Kp相同的情况下,不同CRRT模式均能有效清除炎性因子,且患者预后无差异,但CVVHDF对小分子溶质的清除率优于CVVH,而CVVH对中大分子溶质的清除率优于CVVHDF。
[Abstract]:Objective to observe the solute clearance in patients with sepsis complicated with acute renal injury (AKI) by different continuous renal replacement therapy (CRRT) model and its dosage. Methods from December 2013 to December 2014, 23 patients with sepsis complicated with AKI who were admitted to the Department of intensive Medicine of the fourth Hospital of Hebei Medical University were selected as the study objects. The patients were divided into continuous veno-venous hemofiltration (CVVH) group (n = 14) and continuous veno-venous hemodiafiltration (CVV HDF) group (n = 9). Both groups were diluted before 100% and the dosage of prescription waste liquid was set at 40.00 ml / kg ~ (-1) 路h ~ (-1). The flow rate of replacement solution in CVVHDF group was the same as that of dialysate. The choice of anticoagulant regimen is determined by the clinician according to the coagulation function of the patient. The general data of patients were collected and the dose of CRRT (including Kapp) was calculated. The prescription CRRT time, actual CRRT time, mechanical ventilation time, residence time of ICU, total hospitalization time of 28 days were recorded. Results there was no significant difference in Kp between the two groups. There was no significant difference between the two groups. There was no significant difference in CRRT time, actual CRRT time, mechanical ventilation time, ICU residence time, total hospitalization time and fatality rate between the two groups (P 0.05). Conclusion when the dose of CRRT is overestimated in different CRRT models, different CRRT models can effectively remove inflammatory factors, and there is no difference in the prognosis of the patients. However, the clearance rate of CVVHDF to small molecule solute was better than that of CVVH, while that of CVVH to medium and macromolecular solute was better than that of CVVHDF.
【作者单位】：河北医科大学第四医院ICU;
【基金】：河北省科技支撑计划项目(14277796D)
【分类号】：R459.7

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