中国全科医学2017，Vol.20Issue(36)：4501-4505,5.DOI:10.3969/j.issn.1007-9572.2017.00.131
连续性血液净化治疗危重症患儿急性肾损伤的临床疗效及其机制研究
Clinical Effect of Continuous Blood Purification on Acute Kidney Injury in Critical Ill Children and Its Mechanism
摘要
Abstract
Objective To estimate the clinical effect and investigate the mechanism of continuous blood purification (CBP)in the treatment of acute kidney injury (AKI)in critical ill children,so as to provide some references for clinical treatment of the disease. Methods We retrospectively selected 44 critical ill children with AKI who received inpatient treatment in Department of Nephrology of Anhui Provincial Children′s Hospital from September 2009 to December 2014. According to the therapeutic regimen,they were divided into medicine treatment group (17 cases,using comprehensive medicine treatment)and CBP treatment group (27 cases,CBP treatment was added when medicine treatment failed after obtaining parent′s informed consents). We collected the children′s baseline characteristics,and recorded the levels of clinical indicators and inflammatory factors measured before treatment,at 24 h,48 h and 1 week after treatment. The clinical efficacy of the two groups was compared. Results Significant interaction effect between treatment method and duration was found on serum potassium,carbon dioxide combing power (CO 2 CP)and serum creatinine levels (P < 0. 05),while this kind of effect was not found on serum sodium,urea nitrogen and cystatin C levels (P > 0. 05). The main effect produced by treatment method was significant on serum potassium level (P < 0. 05),but was not significant on serum sodium,CO 2 CP,urea nitrogen,serum creatinine and cystatin C levels (P > 0. 05). The main effect exerted by treatment duration was significant on serum sodium,CO 2 CP,urea nitrogen, serum creatinine and cystatin C levels (P < 0. 05),but was not significant on serum potassium level (P > 0. 05). In the CBP treatment group,the levels of urea nitrogen,serum creatinine and cystatin C at 48 h after treatment were significantly lower than those before treatment (P < 0. 05);the levels of serum potassium,urea nitrogen,serum creatinine and cystatin C at 1 week after treatment were significantly lower than those before treatment (P < 0. 05). In the medicine treatment group,it was observed that the serum potassium level increased while urea nitrogen and serum creatinine levels decreased at 1 week after treatment (P <0. 05). Interaction effect between treatment method and duration on TNF-α,IL-6 and IL-10 levels was identified as well (P < 0. 05). The main effects produced by treatment method on TNF-α,IL-6 and IL-10 levels were significant (P <0. 05). The main effects exerted by treatment duration on TNF-α,IL-6 and IL-10 levels were significant (P < 0. 05). At 24 h after treatment,in the CBP treatment group,the TNF-α and IL-6 levels were found to be decreased (P < 0. 05). Moreover,in this group,at 48 h,1 week after treatment,the TNF-α,IL-6 and IL-10 levels declined significantly compared with those before treatment (P < 0. 05). The overall response rate in the CBP treatment group (96. 3％,26 / 27)was greater than that in the medicine treatment group (70. 6％,12 / 17 ) (P < 0. 05 ). Conclusion Compared with the comprehensive medicine treatment,CBP treatment may be more effective for critical ill children with AKI,which can effectively regulate the inflammatory cytokines level and improve the immune function.关键词
急性肾损伤/儿童/血液透析滤过Key words
Acute kidney injury/Child/Hemodiafiltration分类
医药卫生引用本文复制引用
徐达良,朱亚凤,江家云,朱颖,方韶晗..连续性血液净化治疗危重症患儿急性肾损伤的临床疗效及其机制研究[J].中国全科医学,2017,20(36):4501-4505,5.基金项目
安徽省自然科学基金资助项目(1608085MH204) （1608085MH204）
