连续性血液净化与间歇性血液透析治疗MODS的临床疗效及对患者实验指标的影响
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摘要
目的探究连续性血液净化与间歇性血液透析治疗多器官功能障碍综合征(MODS)患者的临床疗效,观察患者生化指标及炎症因子水平变化,旨在提升MODS患者的存活率及生活质量。方法选取医院2016年6月-2018年4月收治的68例MODS患者,随机分成两组,各34例,研究组患者接受连续性血液净化治疗,对照组患者接受间歇性血液透析治疗。观察两组患者的临床疗效,记录患者治疗前后生化指标、炎症因子及马歇尔·霍尔氏病(Marshall)评分变化。结果两组治疗后的BUN、Cr、HCO_3、pH均优于治疗前(P<0.05),且治疗后1d、2d、3d研究组BUN、Cr、HCO_3生化指标水平均优于对照组(P<0.05);治疗后1d、2d两组pH值比较无差异,但治疗3d后研究组的pH值高于对照组(P<0.05);研究组患者每日的补液摄入量多于对照组,充血性心力衰竭发生率低于对照组(P<0.05);治疗后6h、24h、48h,研究组炎症因子IL-6、TNF-α水平均低于对照组,差异有统计学意义(P<0.05);治疗后研究组Marshall评分低于对照组(P <0.05)。结论连续性血液净化治疗MODS患者的临床效果优于间歇性血液透析治疗,可促进BUN、Cr、HCO_3、pH各生化指标稳定,降低外周血细胞因子水平和Marshall评分,具有很好的应用价值。
OBJECTIVE To observe the clinical effects of continuous blood purification and intermittent hemodialysis on treatment of patients with multiple organ dysfunction syndrome(MODS)and investigate the levels of biochemical indexes and inflammatory factors so as to raise the survival rate and quality of life of the patients with MODS.METHODS A total of 68 patients with MODS who were treated in the hospital from Jun 2016 to Apr 2018 were enrolled in the study and randomly divided into two groups,with 34 cases in each group.The study group was treated with continuous blood purification,while the control group was treated with intermittent hemodialysis.The clinical effects of the two groups of patients were observed,and the levels of biochemical indexes and inflammatory factors as well as Marshall scores of the patients were recorded before and after the treatment.RESULTS BUN,Cr,HCO_3,and pH of the two groups of patients were better after the treatment than before the treatment,and the levels of biochemical indexes BUN,Cr and HCO_3 of the study group were better than those of the control group after the treatment for 1,2 and 3 days(P<0.05).There was no significant difference in the pH value between the two groups after the treatment for 1 and 2 days,however,the pH value of the study group was significantly higher than that of the control group after the treatment for 3 days(P<0.05).The daily fluid intake of the study group was significantly more than that of the control group,and the incidence of congestive heart failure of the study group was lower than that of the control group(P<0.05).The levels of inflammatory factors IL-6 and TNF-αof the study group were lower than those of the control group after the treatment for 6,24 and 48 hours,and there were significant differences(P<0.05);the Marshall scores of the study group were significantly lower than those of the control group after the treatment(P<0.05).CONCLUSION The continuous blood purification can achieve more remarkable clinical effect on treatment of the patients with MODS than the intermittent hemodialysis,it may promote the stability of BUN,Cr,HCO_3 and pH and reduce the levels of peripheral blood cytokines as well as Marshall scores,with the application value high.
OBJECTIVE To observe the clinical effects of continuous blood purification and intermittent hemodialysis on treatment of patients with multiple organ dysfunction syndrome(MODS)and investigate the levels of biochemical indexes and inflammatory factors so as to raise the survival rate and quality of life of the patients with MODS.METHODS A total of 68 patients with MODS who were treated in the hospital from Jun 2016 to Apr 2018 were enrolled in the study and randomly divided into two groups,with 34 cases in each group.The study group was treated with continuous blood purification,while the control group was treated with intermittent hemodialysis.The clinical effects of the two groups of patients were observed,and the levels of biochemical indexes and inflammatory factors as well as Marshall scores of the patients were recorded before and after the treatment.RESULTS BUN,Cr,HCO_3,and pH of the two groups of patients were better after the treatment than before the treatment,and the levels of biochemical indexes BUN,Cr and HCO_3 of the study group were better than those of the control group after the treatment for 1,2 and 3 days(P<0.05).There was no significant difference in the pH value between the two groups after the treatment for 1 and 2 days,however,the pH value of the study group was significantly higher than that of the control group after the treatment for 3 days(P<0.05).The daily fluid intake of the study group was significantly more than that of the control group,and the incidence of congestive heart failure of the study group was lower than that of the control group(P<0.05).The levels of inflammatory factors IL-6 and TNF-αof the study group were lower than those of the control group after the treatment for 6,24 and 48 hours,and there were significant differences(P<0.05);the Marshall scores of the study group were significantly lower than those of the control group after the treatment(P<0.05).CONCLUSION The continuous blood purification can achieve more remarkable clinical effect on treatment of the patients with MODS than the intermittent hemodialysis,it may promote the stability of BUN,Cr,HCO_3 and pH and reduce the levels of peripheral blood cytokines as well as Marshall scores,with the application value high.
引文
[1]王梅英,张月辉,邹世海,等.连续性血液净化对重型狼疮性肾炎合并急性肾损伤患者PYK2信号转导途径的影响[J].中国血液净化,2017,16(1):20-25.
[2]布合力其·麦麦提,张蕾,莫颖.血液净化治疗多器官功能障碍综合征患者36例临床观察[J].中国医药指南,2017,15(10):39-40.
[3]李万华.连续性血液净化对多器官功能障碍综合征凝血功能的影响[J].实用中西医结合临床,2017,17(4):63-64.
[4]江乐,应利君,吕铁.乳酸清除率对感染性创面导致脓毒性休克患者疗效与生存状况的评估价值[J].中华医院感染学杂志,2017,27(9):1959-1962.
[5]毕展建,高飞,时玲燕,等.RASS评分对感染性休克患者改良早期目标导向治疗的探讨[J].中华医院感染学杂志,2016,26(19):4422-4424.
[6]张慧松,陈旭坤,毛欢欢,等.慢性肾衰竭患者合并急性肾损伤感染的临床危险因素分析[J].中华医院感染学杂志,2016,26(10):2305-2307.
[7]Silva VTDCE,Costalonga EC,Oliveira APL,et al.Evaluation of intermittent hemodialysis in critically Ill cancer patients with acute kidney injury using single-pass batch equipment[J].PLoS One,2016,11(3):e0149706.
[8]Si X,Li J,Bi X,et al.Clinical evaluation of high-volume hemofiltration with hemoperfusion followed by intermittent hemodialysis in the treatment of acute wasp stings complicated by multiple organ dysfunction syndrome[J].PLoS One,2015,10(7):e0132708.
[9]Truche AS,Darmon M,Bailly S,et al.Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients:impact on mortality and renal recovery[J].Intensive Care Med,2016,42(9):1408-1417.
[10]Basu B,Mahapatra TKS,Roy B,et al.Efficacy and outcomes of continuous peritoneal dialysis versus daily intermittent hemodialysis in pediatric acute kidney injury[J].Pediatr Nephrol,2016,31(10):1681-1689.
[11]Brkovic T,Burilovic E,Puljak L.Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis:a systematic review[J].Patient Prefer Adherence,2016,10:1131-1150.
[12]Kwizera A,Tumukunde J,Ssemogerere L,et al.Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an African intensive care unit[J].Biomed Res Int,2016,2016:2015251.
[13]Komaru Y,Inokuchi R,Ueda Y,et al.Use of the anion gap and intermittent hemodialysis following continuous hemodiafiltration in extremely high dose acute-on-chronic lithium poisoning:A case report[J].Hemodial Int,2018,22(1):E15-E18.
[14]Marano M,Marano S,Gennari FJ.Beyond bicarbonate:complete acid-base assessment in patients receiving intermittent hemodialysis[J].Nephrol Dial Transplant,2017,32(3):528-533.
[15]Aniort J,Ait Hssain A,Pereira B,et al.Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients[J].Crit Care,2016,20:43.
[16]Liesenfeld KH,Gruenenfelder F,Clemens A.Enhanced elimination of dabigatran:identifying the appropriate patient for the use of continuous venovenous hemodialysis instead of intermittent hemodialysis-A simulation analysis[J].J Clin Pharmacol,2016,56(5):597-608.
[17]Artunc F,Muehlbacher T,Baumann D,et al.Removal of dabigatran is superior by sustained low efficient dialysis(SLED)compared to intermittent hemodialysis[J].Blood Purif,2015,39(4):331-332.
[18]St Bernard R,Chodirker L,Masih-Khan E,et al.Efficacy,toxicity and mortality of autologous SCT in multiple myeloma patients with dialysis-dependent renal failure[J].Bone Marrow Transplant,2015,50(1):95-99.
[19]梁少梅,沈清.连续性血液净化对MODS患者中性粒细胞的影响[J].中华医学教育探索杂志,2010,9(4):574-576.
[20]王建文,彭佑铭,陈星,等.连续性血液透析滤过在MODS患者治疗中的临床疗效[J].中国血液净化,2005,4(9):491-493.
[21]谢芸芝,陶蓉.连续性血液净化对MODS合并ARF患者炎性因子和凝血功能的影响[J].临床和实验医学杂志,2013,12(12):970-971.
[22]贾顺莲,王玉英,高新英,等.连续性高容量血液滤过对多器官功能障碍综合征患者靶器官功能、C反应蛋白、肿瘤坏死因子-α与内皮损伤因子水平的影响[J].实用临床医药杂志,2017,21(19):48-51.
[23]刘峰,黄正根,彭毅志,等.严重烧伤早期行连续性血液净化治疗的可行性及疗效随机对照临床试验[J].中华烧伤杂志,2016,32(3):133-139.
[24]李峰.连续性血液净化对重症急性胰腺炎合并MODS患者血液流变学、血清炎症因子的影响[J].标记免疫分析与临床,2017,24(10):1133-1137.
[25]周晓萍,张金黎.连续性血液净化与间歇性血液透析治疗老年急性肾功能衰竭的疗效比较[J].昆明医科大学学报,2003,24(2):65-67.
[2]布合力其·麦麦提,张蕾,莫颖.血液净化治疗多器官功能障碍综合征患者36例临床观察[J].中国医药指南,2017,15(10):39-40.
[3]李万华.连续性血液净化对多器官功能障碍综合征凝血功能的影响[J].实用中西医结合临床,2017,17(4):63-64.
[4]江乐,应利君,吕铁.乳酸清除率对感染性创面导致脓毒性休克患者疗效与生存状况的评估价值[J].中华医院感染学杂志,2017,27(9):1959-1962.
[5]毕展建,高飞,时玲燕,等.RASS评分对感染性休克患者改良早期目标导向治疗的探讨[J].中华医院感染学杂志,2016,26(19):4422-4424.
[6]张慧松,陈旭坤,毛欢欢,等.慢性肾衰竭患者合并急性肾损伤感染的临床危险因素分析[J].中华医院感染学杂志,2016,26(10):2305-2307.
[7]Silva VTDCE,Costalonga EC,Oliveira APL,et al.Evaluation of intermittent hemodialysis in critically Ill cancer patients with acute kidney injury using single-pass batch equipment[J].PLoS One,2016,11(3):e0149706.
[8]Si X,Li J,Bi X,et al.Clinical evaluation of high-volume hemofiltration with hemoperfusion followed by intermittent hemodialysis in the treatment of acute wasp stings complicated by multiple organ dysfunction syndrome[J].PLoS One,2015,10(7):e0132708.
[9]Truche AS,Darmon M,Bailly S,et al.Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients:impact on mortality and renal recovery[J].Intensive Care Med,2016,42(9):1408-1417.
[10]Basu B,Mahapatra TKS,Roy B,et al.Efficacy and outcomes of continuous peritoneal dialysis versus daily intermittent hemodialysis in pediatric acute kidney injury[J].Pediatr Nephrol,2016,31(10):1681-1689.
[11]Brkovic T,Burilovic E,Puljak L.Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis:a systematic review[J].Patient Prefer Adherence,2016,10:1131-1150.
[12]Kwizera A,Tumukunde J,Ssemogerere L,et al.Clinical characteristics and 30-day outcomes of intermittent hemodialysis for acute kidney injury in an African intensive care unit[J].Biomed Res Int,2016,2016:2015251.
[13]Komaru Y,Inokuchi R,Ueda Y,et al.Use of the anion gap and intermittent hemodialysis following continuous hemodiafiltration in extremely high dose acute-on-chronic lithium poisoning:A case report[J].Hemodial Int,2018,22(1):E15-E18.
[14]Marano M,Marano S,Gennari FJ.Beyond bicarbonate:complete acid-base assessment in patients receiving intermittent hemodialysis[J].Nephrol Dial Transplant,2017,32(3):528-533.
[15]Aniort J,Ait Hssain A,Pereira B,et al.Daily urinary urea excretion to guide intermittent hemodialysis weaning in critically ill patients[J].Crit Care,2016,20:43.
[16]Liesenfeld KH,Gruenenfelder F,Clemens A.Enhanced elimination of dabigatran:identifying the appropriate patient for the use of continuous venovenous hemodialysis instead of intermittent hemodialysis-A simulation analysis[J].J Clin Pharmacol,2016,56(5):597-608.
[17]Artunc F,Muehlbacher T,Baumann D,et al.Removal of dabigatran is superior by sustained low efficient dialysis(SLED)compared to intermittent hemodialysis[J].Blood Purif,2015,39(4):331-332.
[18]St Bernard R,Chodirker L,Masih-Khan E,et al.Efficacy,toxicity and mortality of autologous SCT in multiple myeloma patients with dialysis-dependent renal failure[J].Bone Marrow Transplant,2015,50(1):95-99.
[19]梁少梅,沈清.连续性血液净化对MODS患者中性粒细胞的影响[J].中华医学教育探索杂志,2010,9(4):574-576.
[20]王建文,彭佑铭,陈星,等.连续性血液透析滤过在MODS患者治疗中的临床疗效[J].中国血液净化,2005,4(9):491-493.
[21]谢芸芝,陶蓉.连续性血液净化对MODS合并ARF患者炎性因子和凝血功能的影响[J].临床和实验医学杂志,2013,12(12):970-971.
[22]贾顺莲,王玉英,高新英,等.连续性高容量血液滤过对多器官功能障碍综合征患者靶器官功能、C反应蛋白、肿瘤坏死因子-α与内皮损伤因子水平的影响[J].实用临床医药杂志,2017,21(19):48-51.
[23]刘峰,黄正根,彭毅志,等.严重烧伤早期行连续性血液净化治疗的可行性及疗效随机对照临床试验[J].中华烧伤杂志,2016,32(3):133-139.
[24]李峰.连续性血液净化对重症急性胰腺炎合并MODS患者血液流变学、血清炎症因子的影响[J].标记免疫分析与临床,2017,24(10):1133-1137.
[25]周晓萍,张金黎.连续性血液净化与间歇性血液透析治疗老年急性肾功能衰竭的疗效比较[J].昆明医科大学学报,2003,24(2):65-67.