不同肾脏替代治疗模式对脓毒症休克合并多脏器功能损害患者的疗效观察

摘要/Abstract

摘要： 目的：比较不同连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）模式对脓毒症休克合并多脏器功能损害患者的临床疗效，为脓毒症休克合并多脏器功能损害的CRRT治疗模式选择提供参考依据。方法：选取我院2015年7月至2017年3月收治的92例脓毒症休克合并多脏器功能损害患者作为研究对象，按照随机数字表法分为连续性静-静脉血液滤过（CVVH）组和连续性静-静脉血液透析滤过（CVVHDF）组，每组各46例，分别给予CVVH及CVVHDF治疗。比较两组患者CRRT参数、治疗转归及治疗前后生化指标变化，分析两种治疗模式对患者预后的影响。结果：两组患者比较，CVVH组矫正剂量（Kpc）、交付剂量（Kd）、实际溶质清除剂量（K）均低于CVVHDF组，差异均有统计学意义（P＜0.05）。两组患者治疗转归比较，差异均无统计学意义（P＞0.05）。两组患者治疗后尿素氮（BUN）、肌酐（Cr）、β2-微球蛋白（β2-MG）、急性生理与慢性健康（APACHEⅡ）评分均较治疗前下降；白细胞介素-6（IL-6）、排尿量均较治疗前升高；CVVH组患者β2-MG下降更为明显，差异均有统计学意义（P＜0.05）。两组患者治疗期间均未见不良反应发生。结论：CVVH与CVVHDF模式治疗脓毒症休克合并多脏器功能损害的效果相仿，CVVHDF清除小分子溶质的能力较强，而CVVH清除中大分子的效果更为理想。

Abstract: Objective： To compare the effects of different continuous renal replacement therapy (CRRT) model in patients with septic shock complicated with multiple organ dysfunction syndrome， and provide reference for selection the CRRT model for septic shock complicated with multiple organ damage. Methods： 92 cases of patients with septic shock complicated with multiple organ dysfunction syndrome in our hospital from July 2015 to March 2017 were selected as subjects.All patients were randomly divided into the continuous venovenous hemofiltration (CVVH) group（n=46）and the continuous venovenous hemodiafiltration (CVVHDF) group（n=46） by random number table method， and treated with CVVH and CVVHDF respectively. The CRRT parameters， treatment outcomes and changes in biochemical parameters before and after treatment were compared between the two groups，and the effects of the two treatment modes on the prognosis of the patients were analyzed. Results：The corrected dose (Kpc)， delivered dose (Kd) and the actual solute clearance dose(K) in the CVVH group were lower than those in the CVVHDF group， and the difference was statistically significant (P<0.05).There was no statistically significant difference between the two groups in treatment outcome (P>0.05). After treatment， blood urea nitrogen (BUN)， creatinine (Cr)， β2-microglobulin (β2-MG)， acute physiology and chronic health evaluation(APACHEⅡ) score were lower than that before treatment， interleukin-6(IL-6) and urine volume increased significantly compared with before treatment， and β2-MG in the CVVH group decreased more obviously， the difference was statistically significant(P＜0.05).No adverse reaction occurred in the two groups during the treatment. Conclusion：The effect of CVVH and CVVHDF treatment on septic shock complicated with multiple organ dysfunction is similar. CVVHDF has better ability to remove small molecule solutes， and the effect of CVVH on macromolecule clearance is more ideal.

杜晓敏,翟磊. 不同肾脏替代治疗模式对脓毒症休克合并多脏器功能损害患者的疗效观察[J]. .

DU Xiaomin and ZHAI Lei. Clinical Observation of Different Renal Replacement Therapy in Patients with Septic Shock Complicated with Multiple Organ Dysfunction Syndrome[J]. .

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