间隙性高容量血液滤过对脓毒症合并急性肾损伤患者疗效观察
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摘要
目的观察间隙性高容量血液滤过(HVHF)在脓毒症合并急性肾损伤(AKI)患者救治中的临床疗效。方法选择32例脓毒症合并AKI患者,其中男性19例,女性13例;年龄29~76岁,平均年龄57.4岁。按照接受血液净化治疗模式不同分为观察组和对照组。观察组18例,其中男性11例,女性7例,年龄(55.3±14.8)岁,体质量(57.7±10.4) kg;对照组14例,其中男性8例,女性6例,年龄(60.1±13.3)岁,体质量(58.1±14.9) kg。对比分析两组血液净化治疗前、治疗12 h及72 h生命体征变化、危重症评分、全身炎症反应指标、血乳酸指标、血清生物化学指标及肾功能,比较两组患者机械通气时间、28 d存活率、透析器凝血情况。结果两组患者治疗后生命体征变化、危重症评分、全身炎症反应指标、血乳酸指标、血清生物化学指标及肾功能指标较治疗前比较,差异有统计学意义(P <0.05);观察组在治疗12 h时各项生命体征变化、危重症评分及全身炎症反应等指标较对照组明显改善(P <0.05);观察组在治疗72 h后全身炎症反应指标较对照组明显改善(P <0.05)。两组机械通气时间比较(8.1 d±3.8 d vs 10.5 d±6.3 d),差异有统计学意义(P <0.05);28 d存活率比较(72.20%vs 57.15%),差异无统计学意义(P> 0.05)。结论间隙性HVHF可以有效清除脓毒症患者炎性介质,显著改善临床症状,降低人力消耗,减少并发症发生率,提高治疗效果。
Objective To assess the therapeutic effect of interstitial high volume hemofiltration(HVHF) in treatment of sepsis patients complicated with acute kidney injury(AKI). Methods A total of 32 sepsis patients complicated with AKI were enrolled, included 19 males and 13 females, aged 29-76 years old with mean age of 57.4 years old. They were divided into observation group[n = 18, 11 males and 7 females, aged(55.3 ± 14.8) years old with body weight of(57.7 ± 10.4) kg] and control group[(n = 14, 8 males and 6 females, aged(60.1 ± 13.3) years old with body weight of(58.1 ± 14.9) kg] by blood purification treatment mode. The vital signs, critical illness scores, systemic inflammation indicators, blood lactate index, serum biochemical parameters and renal function before treatment, 12-hour and 72-hour after treatment, mechanical ventilation time,28-day survival rate and dialyzer coagulation were compared between 2 groups. Results The changes of vital signs, critical illness scores, systemic inflammation index, blood lactate index, serum biochemical index and renal function index between 2 groups were statistically significant(P < 0.05). At 12 hours after treatment, the changes of vital signs, critical scores and inflammatory response in observation group were significantly better than those of control group(P < 0.05). At 72 hours after treatment,the systemic inflammation index in observation group was significantly better than that of control group(P < 0.05). There was statistically significant difference in mechanical ventilation time(8.1 d ± 3.8 d vs 10.5 d ± 6.3 d) between 2 groups(P < 0.05).There was no significant difference in 28-day survival rate(72.20 % vs 57.15 %)(P > 0.05). Conclusion It is demonstrated that interstitial HVHF could effectively eliminate inflammatory mediators in patients with sepsis, significantly improve the clinical symptoms and treatment effect, reduce human consumption and incidence of complications.
Objective To assess the therapeutic effect of interstitial high volume hemofiltration(HVHF) in treatment of sepsis patients complicated with acute kidney injury(AKI). Methods A total of 32 sepsis patients complicated with AKI were enrolled, included 19 males and 13 females, aged 29-76 years old with mean age of 57.4 years old. They were divided into observation group[n = 18, 11 males and 7 females, aged(55.3 ± 14.8) years old with body weight of(57.7 ± 10.4) kg] and control group[(n = 14, 8 males and 6 females, aged(60.1 ± 13.3) years old with body weight of(58.1 ± 14.9) kg] by blood purification treatment mode. The vital signs, critical illness scores, systemic inflammation indicators, blood lactate index, serum biochemical parameters and renal function before treatment, 12-hour and 72-hour after treatment, mechanical ventilation time,28-day survival rate and dialyzer coagulation were compared between 2 groups. Results The changes of vital signs, critical illness scores, systemic inflammation index, blood lactate index, serum biochemical index and renal function index between 2 groups were statistically significant(P < 0.05). At 12 hours after treatment, the changes of vital signs, critical scores and inflammatory response in observation group were significantly better than those of control group(P < 0.05). At 72 hours after treatment,the systemic inflammation index in observation group was significantly better than that of control group(P < 0.05). There was statistically significant difference in mechanical ventilation time(8.1 d ± 3.8 d vs 10.5 d ± 6.3 d) between 2 groups(P < 0.05).There was no significant difference in 28-day survival rate(72.20 % vs 57.15 %)(P > 0.05). Conclusion It is demonstrated that interstitial HVHF could effectively eliminate inflammatory mediators in patients with sepsis, significantly improve the clinical symptoms and treatment effect, reduce human consumption and incidence of complications.
引文
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[4] MENG Xin-ke. Critical illness score:evaluation, prediction,treatment[M]. Beijing:People’s Medical Publishing House,2008.[孟新科.急危重症评分:评价、预测、处理[M].北京:人民卫生出版社,2008.]
[5] BO Lu-long, BIAN Jin-jun, DENG Xiao-ming. New definition and clinical criteria for sepsis and septic shock in 2016:back to the nature, head for the future[J]. Chinese Journal of Anesthesiology, 2016, 36(3):259-262.[薄禄龙,卞金俊,邓小明. 2016年脓毒症最新定义与诊断标准:回归本质重新出发[J].中华麻醉学杂志,2016,36(3):259-262.]
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[7] ZHONG Wei-zhou, LIU Qing-shan, OU Yuan-tong, et al.Correlation between shock index and inflammatory, oxidative stress as well as target organ damage in patients with sepsis[J]. Journal of Hainan Medical College, 2017, 23(4):464-466.[钟伟州,刘青山,欧远通,等.脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性研究[J].海南医学院学报,2017,23(4):464-466.]
[8] ZONG Jing-jing, LIU Chun-sheng, FU Xiao-fei, et al. Effect of CRRT on the clearance of antibiotics in the treatment of sepsis[J]. Chinese Critical Care Medicine, 2017, 29(7):662-665.[宗景景,刘春生,付晓菲,等. CRRT对脓毒症治疗中抗菌药物清除作用的影响[J].中华危重病急救医学,2017,29(7):662-665.]
[9] Ricci Z, Romagnoli S, Ronco C. Renal replacement therapy[J]. F1000research, 2016, 5:F1000 Faculty Rev-103.
[10] WANG Hua, LI Ping. Effect of continuous blood purification on severe acute pancreatitis[J]. Biomedical Engineering and Clinical Medicine, 2017, 21(4):404-407.[王花,李萍.连续性血液净化治疗在急性重症胰腺炎中的应用[J].生物医学工程与临床,2017,21(4):404-407.]
[11] Hu D, Sun S, Zhu B, et al. Effects of coupled plasma filtration adsorption on septic patients with multiple organ dysfunction syndrome[J]. Ren Fail, 2012, 34(7):834-839.
[12] LI Xiao-li, LIU Lu-yi, CHU Jing, et al. Study of coupled plasma filtration adsorption therapy for patients with severe infection and multiple organ dysfunction syndromes[J]. Chinese Journal of Emergency Medicine, 2017, 26(8):919-923.[李小丽,刘鲁沂,初静,等.配对血浆吸附滤过治疗重症脓毒症并发多器官功能障碍综合征的研究[J].中华急诊医学杂志,2017,26(8):919-923.]
[13] WANG Li-jun, YU Mu-ming, CHAI Yan-fen. Clinical application and progress of high volume hemofiltration in the treatment of sepsis[J]. Chinese Journal of Emergency Medicine,2017, 26(2):244-247.[王力军,余慕明,柴艳芬.高容量血液滤过在脓毒症治疗中的临床应用及进展[J].中华急诊医学杂志,2017,26(2):244-247.]
[14] Herrera-Gutiérrez ME, Seller-Pérez G, Arias-VerdúD, et al.A comparison of the effect of convection against diffusion in hemodynamics and cytokines clearance in an experimental model of septic shock[J]. J Trauma Acute Care Surg, 2012, 73(4):855-860.
[15] XUE Lu, ZHANG Min, ZHAO Ping, et al. Experimental study on the effect of high volume hemofiltration to septic shock induced acute kidney injury[J]. Chinese Journal of Blood Purification, 2014, 13(11):741-746.[薛露,张敏,赵平,等.高容量血液滤过对感染性休克所致急性肾损伤影响的实验研究[J].中国血液净化,2014,13(11):741-746.]
[16] JIANG Bo-jie, WANG Chang-hui, PENG Hu, et al. Continuous high-volume haemofiltration in treatment of severe sepsis with acute respiratory distress syndrome[J]. Journal of Tongji University:Medical Science, 2014, 35(2):77-81.[江波杰,王昌惠,彭沪,等.连续性血液净化治疗重症脓毒症合并ARDS的临床研究[J].同济大学学报:医学版,2014,35(2):77-81.]
[17] LIN Rong-hai, JIANG Yong-po, ZHANG Sheng, et al. Continuous blood purification treatment for sepsis-induced myocardial depression in pigs[J]. Chinese Journal of Emergency Medicine, 2016, 25(12):1290-1293.[林荣海,蒋永泼,张胜,等.连续性血液净化治疗对脓毒症心肌抑制保护作用的研究[J].中华急诊医学杂志,2016,25(12):1290-1293.]
[18] Li C, Zhang P, Cheng X, et al. High-volume hemofiltration reduces the expression of myocardial tumor necrosis factoralpha in septic shock pigs[J]. Artif Organs, 2013, 37(2):196-202.
[19] Joannes-Boyau O, HonoréPM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury(IVOIRE study):a multicentre randomized controlled trial[J]. Intensive Care Med, 2013, 39(9):1535-1546.
[2] Lameire N, Biesen WV, Vanholder R. Acute renal failure[J].Lancet, 2008, 372(9653):1863-1865.
[3] HE Tie-niu, LIU Bao, TAO Xiao-gen, et al. The application superiority of daytime continuous high-volume hemofiltration in patients with multiple organ dysfunction syndrome[J]. Chinese Journal of Blood Purification, 2010, 9(6):311-314.[何铁牛,刘宝,陶晓根,等.日间高容量血液滤过在多脏器功能障碍综合征中应用的优势[J].中国血液净化,2010,9(6):311-314.]
[4] MENG Xin-ke. Critical illness score:evaluation, prediction,treatment[M]. Beijing:People’s Medical Publishing House,2008.[孟新科.急危重症评分:评价、预测、处理[M].北京:人民卫生出版社,2008.]
[5] BO Lu-long, BIAN Jin-jun, DENG Xiao-ming. New definition and clinical criteria for sepsis and septic shock in 2016:back to the nature, head for the future[J]. Chinese Journal of Anesthesiology, 2016, 36(3):259-262.[薄禄龙,卞金俊,邓小明. 2016年脓毒症最新定义与诊断标准:回归本质重新出发[J].中华麻醉学杂志,2016,36(3):259-262.]
[6] MEI Chang-lin, YE Chao-yang, RONG Shu. Practical dialysis manual[M]. 2nd edition. Beijing:People’s Medical Publishing House, 2009:53-115.[梅长林,叶朝阳,戎殳.实用透析手册[M].第2版.北京:人民卫生出版社,2009:53-115.]
[7] ZHONG Wei-zhou, LIU Qing-shan, OU Yuan-tong, et al.Correlation between shock index and inflammatory, oxidative stress as well as target organ damage in patients with sepsis[J]. Journal of Hainan Medical College, 2017, 23(4):464-466.[钟伟州,刘青山,欧远通,等.脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性研究[J].海南医学院学报,2017,23(4):464-466.]
[8] ZONG Jing-jing, LIU Chun-sheng, FU Xiao-fei, et al. Effect of CRRT on the clearance of antibiotics in the treatment of sepsis[J]. Chinese Critical Care Medicine, 2017, 29(7):662-665.[宗景景,刘春生,付晓菲,等. CRRT对脓毒症治疗中抗菌药物清除作用的影响[J].中华危重病急救医学,2017,29(7):662-665.]
[9] Ricci Z, Romagnoli S, Ronco C. Renal replacement therapy[J]. F1000research, 2016, 5:F1000 Faculty Rev-103.
[10] WANG Hua, LI Ping. Effect of continuous blood purification on severe acute pancreatitis[J]. Biomedical Engineering and Clinical Medicine, 2017, 21(4):404-407.[王花,李萍.连续性血液净化治疗在急性重症胰腺炎中的应用[J].生物医学工程与临床,2017,21(4):404-407.]
[11] Hu D, Sun S, Zhu B, et al. Effects of coupled plasma filtration adsorption on septic patients with multiple organ dysfunction syndrome[J]. Ren Fail, 2012, 34(7):834-839.
[12] LI Xiao-li, LIU Lu-yi, CHU Jing, et al. Study of coupled plasma filtration adsorption therapy for patients with severe infection and multiple organ dysfunction syndromes[J]. Chinese Journal of Emergency Medicine, 2017, 26(8):919-923.[李小丽,刘鲁沂,初静,等.配对血浆吸附滤过治疗重症脓毒症并发多器官功能障碍综合征的研究[J].中华急诊医学杂志,2017,26(8):919-923.]
[13] WANG Li-jun, YU Mu-ming, CHAI Yan-fen. Clinical application and progress of high volume hemofiltration in the treatment of sepsis[J]. Chinese Journal of Emergency Medicine,2017, 26(2):244-247.[王力军,余慕明,柴艳芬.高容量血液滤过在脓毒症治疗中的临床应用及进展[J].中华急诊医学杂志,2017,26(2):244-247.]
[14] Herrera-Gutiérrez ME, Seller-Pérez G, Arias-VerdúD, et al.A comparison of the effect of convection against diffusion in hemodynamics and cytokines clearance in an experimental model of septic shock[J]. J Trauma Acute Care Surg, 2012, 73(4):855-860.
[15] XUE Lu, ZHANG Min, ZHAO Ping, et al. Experimental study on the effect of high volume hemofiltration to septic shock induced acute kidney injury[J]. Chinese Journal of Blood Purification, 2014, 13(11):741-746.[薛露,张敏,赵平,等.高容量血液滤过对感染性休克所致急性肾损伤影响的实验研究[J].中国血液净化,2014,13(11):741-746.]
[16] JIANG Bo-jie, WANG Chang-hui, PENG Hu, et al. Continuous high-volume haemofiltration in treatment of severe sepsis with acute respiratory distress syndrome[J]. Journal of Tongji University:Medical Science, 2014, 35(2):77-81.[江波杰,王昌惠,彭沪,等.连续性血液净化治疗重症脓毒症合并ARDS的临床研究[J].同济大学学报:医学版,2014,35(2):77-81.]
[17] LIN Rong-hai, JIANG Yong-po, ZHANG Sheng, et al. Continuous blood purification treatment for sepsis-induced myocardial depression in pigs[J]. Chinese Journal of Emergency Medicine, 2016, 25(12):1290-1293.[林荣海,蒋永泼,张胜,等.连续性血液净化治疗对脓毒症心肌抑制保护作用的研究[J].中华急诊医学杂志,2016,25(12):1290-1293.]
[18] Li C, Zhang P, Cheng X, et al. High-volume hemofiltration reduces the expression of myocardial tumor necrosis factoralpha in septic shock pigs[J]. Artif Organs, 2013, 37(2):196-202.
[19] Joannes-Boyau O, HonoréPM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury(IVOIRE study):a multicentre randomized controlled trial[J]. Intensive Care Med, 2013, 39(9):1535-1546.