持续低效血液透析联合血液灌流治疗脓毒症的疗效及对肾脏的保护作用

摘要

目的 探讨持续低效血液透析(SLED)联合血液灌流(HP)治疗脓毒症的临床疗效,以及其对肾脏的保护作用.方法 将62例脓毒症合并急性肾损伤(AKI)患者随机等分为联合组和对照组,在常规治疗的基础上,对照组应用HP治疗,透析时间为每日2h,联合组初始治疗2h HP和SLED同时进行,2h后继续行SLED治疗10 ～ 12h.两组均治疗3天.分别于治疗前后检测炎性因子、肾功能及心功能指标,同时观察两组患者的血流动力学改善情况.结果 与治疗前比较,治疗后12、24、48h,两组IL-6、IL-10、TNF-α及Scr、BNP均明显改善(P＜0.05),而联合组治疗后48h的各炎性因子显著低于对照组,治疗后12、24、48h联合组Scr、BNP水平均显著低于对照组(P＜0.05);联合组治疗后12、24、48h之间CVP、MAP水平差异均无统计学意义(P＞0.05),而上述各时点CVP、MAP水平均显著高于对照组(P＜0.05).结论 HP+ SLED治疗脓毒症合并AKI患者,可有效清除体内炎性介质,促进肾功能恢复,稳定血流动力学状态.%Objective To explore the clinical effect of sustained low-efficient dialysis (SLED) combined with hemoperfusion(HP)in sepsis patients,and its protection for the kidney.Methods Sixty two patients of sepsis with acute kidney injury(AKI) were randomly divided into two groups.Based on routine treatment,control group (n =31) was treated with HP alone for 2h per day,and combined group (n =31) was treated with HP and SLED at the first 2h,and SLED for the next 10-12h.All the patients were treated for 3 days.The inflammation factors and index of renal function were detected before and after treatment,and change of haemodynamics were observed and analyzed.Results After treatment for 12,24,48h,the TNF-α,IL-6,IL-10 and Scr,BNP in both groups were all improved,while the inflammation factors in combined groups at 48h after treatment were significantly lower than those in control group,and levels of Scr and BNP at 12,24,48h after treatment were all lower than those in control group (P ＜ 0.05).There were no significant differences on the levels of CVP,MAP at 12,24,48h after treatment in combined groups (P ＞ 0.05),while these indicators were all higher than those in control group (P ＜ 0.05).Conclusion HP combined with SLED in treating sepsis with AKI can effectively remove inflammatory mediators,promote kidney function recovery and stability of hemodynamic.