中国全科医学2016，Vol.19Issue(18)：2145-2150,6.DOI:10.3969/j.issn.1007-9572.2016.18.007
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
Effects of Different Modes of CRRT and Doses on the Solute Clearance of Patients With Sepsis-induced AKI
摘要
Abstract
Objective To observe the effect of different modes of continuous renal replacement therapy(CRRT)on the solute clearance of patients with sepsis - induced acute kidney injurt(AKI). Methods We enrolled 23 patients with sepsis- induced AKI who were hospitalized in the intensive - care unit of the Fourth Hospital of Hebei Medical University from December 2013 to December 2014. The patients were randomly divided into continuous venous - venous hemofiltration(CVVH) group with 14 patients and continuous venovenous hemodiafiltration(CVVHDF)group with 9 patients by random number table method. Both groups used 100 % pre - dilution,and Kp was prepared as 40. 00 ml·kg - 1 ·h - 1. The fluid displacement velocity and dialyzate velocity of CVVHDF group were the same. Clinicians decided anticoagulation therapies according to coagulation function. The general data of the patients were collected,and CRRT dosages( Kp,Kpc,Kd and K) were calculated. Prescribed CRRT time,actual CRRT time,mechanical ventilation time,ICU time,total hospitalization time and 28 d mortality of the patients were recorded. Results The two groups were not significantly different in Kp(P > 0. 05);CVVHDF group was higher than CVVH group in Kpc,Kd and KCr (P < 0. 05). In patients of CVVH group and CVVHDF group,Kpc,Kd and KCr were lower than Kp,Kd and KCr were lower than Kpc,KCr was lower than Kd(P < 0. 05). CVVHDF group was lower than CVVH group in Kβ2 - M ,KIL-6 and KIL-8 (P < 0. 05). The two groups were not significantly different in prescribed CRRT time, actual CRRT time,mechanical ventilation time,ICU time,total hospitalization time and 28 d mortality ( P > 0. 05 ). Conclusion In different CRRT modes,the dosage of CRRT is highly estimated. With same Kp,different CRRT modes can effectively eliminate inflammatory mediators,and there is no different in the prognosis of patients. However,CVVHDF is superior to CVVH in the clearance rate of small solute, and CVVH is superior to CVVHDF in the clearance rate of macromolecular solute.关键词
肾替代疗法/脓毒症/急性肾损伤/血液透析滤过/血液滤过/清除率Key words
Renal replacement therapy/Sepsis/Acute kidney injury/Hemodiafiltration/Hemofiltration/Clearance分类
医药卫生引用本文复制引用
陈玉红,郑明,李斌,邢冬,胡振杰,赵钗..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[J].中国全科医学,2016,19(18):2145-2150,6.基金项目
河北省科技支撑计划项目 （）
