创伤伴急性肾损伤患者采用连续性静脉－静脉血液滤过治疗对促进肾功能恢复的影响

摘要

目的：探讨连续性静脉－静脉血液滤过治疗创伤伴急性肾损伤患者临床效果。方法回顾性分析80例创伤伴急性肾损伤患者临床情况，其中以常规基础治疗者为对照组，40例；另外40例于对照组治疗基础上实施连续性静脉－静脉血液滤过治疗。分别于治疗前及治疗后2小时检测患者凝血功能指标[凝血酶原时间（PT）、血小板计数及活化部分凝血酶原时间（APTT）]；分别于治疗前及治疗后3小时检测其血清尿素氮（BUN）及血肌酐（Scr）、白介素－6（IL－6）、白介素－10（IL－10）、肿瘤坏死因子－α（TNF－α）。统计患者预后情况。结果两组患者治疗后2小时 PT、APTT高于治疗前，而血小板计数水平明显低于治疗前，然观察组各项指标升高或下降程度与对照组比较，P<0．05。两组患者治疗后各炎症介质指标水平与治疗前比较，P<0．05；且观察组优于对照组，P<0．05；两组患者治疗后3小时BUN及Scr水平较治疗前显著下降，观察组下降程度优于对照组，P<0．05。观察组平均住院时间明显短于对照组，死亡率明显低于对照组，P<0．05。结论连续性静脉－静脉血液滤过治疗创伴后急性肾损伤患者安全且可有效保护患者肾功能。%Objective To explore clinical effects of continuous venous-venous hemofiltration on the traumatic acute kidney injury. Methods A retrospective analysis of 80 patients with traumatic acute kidney injury. 40 cases were divided in to control group, the regular basis treatment was applied. 40 cases were divided into the observation group, the continuous venous-venous hemofiltration were applied. 2h before and after treatment the coagulation parameters were detected such as prothrombin time (PT), platelet count and activated partial thromboplastin time (APTT). 3h before and after treatment, the serum urea nitrogen (BUN) and serum creatinine (Scr), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor -α(TNF-α) were detected. The prognosis was statistically analyzed. Results 2h after treatment, PT, APTT were higher than that before treatment, and platelet count was significantly lower than that before treatment, P<0.05. The level of inflammatory mediators were decreased after treatment in the two group, P<0.05, and the observation group was better than the control group, P<0.05. BUN and Scr decreased after treatment in the two group, P<0.05, and the observation group was better than the control group, P<0.05. The average hospital stay in the observation group was significantly shorter than that in the control group, mortality was significantly lower than that in the control group, P<0.05. Conclusion Continuous venous-venous hemofil-tration treated on the patients with invasive acute kidney injury was safe and effective to protect the renal function.