中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (04): 282-285.doi: 10.3969/j.issn.1671-4091.2024.04.009

• 临床研究 • 上一篇    下一篇

延时的间歇性肾脏替代治疗用于维持性血液透析替代治疗的临床观察

席春生   王谨涵    蔡蕊莲    方春天    肖燎原    刘 飞    高 健   

  1. 730050 兰州，1中国人民解放军联勤保障部队第九四〇医院肾脏病科
  • 收稿日期:2023-09-19 修回日期:2024-02-13 出版日期:2024-04-12 发布日期:2024-04-12
  • 通讯作者: 席春生 E-mail:chunshxi@sina.com

Clinical investigation of prolonged intermittent renal replacement therapy to substitute for maintenance hemodialysis

XI Chun-sheng, WANG Jin-han, CAI Rui-lian, FANG Chun-tian, XIAO Liao-yuan, LIU Fei, GAO Jian   

  1. Department of Nephrology, the 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, China
  • Received:2023-09-19 Revised:2024-02-13 Online:2024-04-12 Published:2024-04-12
  • Contact: 730050 兰州，1中国人民解放军联勤保障部队第九四〇医院肾脏病科 E-mail:chunshxi@sina.com

摘要： 目的  观察延时的间歇性肾脏替代治疗(prolonged intermittent renal-replacement therapy,PIRRT)用于维持性血液透析(maintenance hemodialysis,MHD)替代治疗的可行性和安全性。 方法  回顾性评估2022年10月—2023年3月中国人民解放军联勤保障部队第九四〇医院的MHD患者因疫情管控需行肾脏替代治疗的临床资料。治疗模式选用前后联合稀释的加速静脉-静脉血液滤过(accelerated venovenous hemofiltration，AVVH)，按治疗剂量分为25～30 ml/(kg·h)组(低剂量组)和50～60 ml/(kg·h)组(高剂量组)。从电子病历收集评估入院首次PIRRT治疗参数、治疗开始时和结束时血清尿素、钾、磷、二氧化碳，计算尿素下降率(URR)、单室模型尿素清除率(spKt/V)以及治疗期间和结束后不良反应等，比较2组上述指标。 结果 低剂量组(n=31)和高剂量组(n=36)患者年龄、男性比例、干体质量、血红蛋白水平比较均无统计学差异(t =1.388、0.459、0.479、0.913，P=0.085、0.498、0.683、0.818)。高剂量组PIRRT血流量、治疗剂量、滤过分数均高于低剂量组(t =14.535、39.358、7.304，均P＜0.001)。2组患者总净超滤量比较无统计学差异(t =1.076，P=0.857)。治疗结束时，2组患者血钾、磷、二氧化碳水平均达正常范围。高剂量组URR及spKt/V均高于低剂量组，差异有统计学意义(t=12.039、5.145，均P＜0.001)。2组患者PIRRT期间均未发生明显不良反应。 结论 PIRRT能够有效纠正MHD患者容量超负荷、电解质和酸碱紊乱；与低剂量PIRRT相比，高剂量PIRRT更能有效降低尿毒症毒素水平，且患者耐受性良好，更适用于MHD的替代治疗。

关键词: 延时的间歇性肾脏替代治疗, 维持性血液透析, 替代治疗

Abstract: Objective  To investigation the efficacy and safety of prolonged intermittent renal replacement therapy (PIRRT) to substitute for maintenance hemodialysis (MHD).  Methods  Clinical data of the patients treated with renal replacement therapy in the 940th Hospital of Joint Logistics Support Force of Chinese PLA between Oct. 2022 to Mar. 2023, at which quarantine procedures were carried out for the epidemic of coronavirus 2019 disease, were retrospectively studied. The patients undergoing pre- and post-dilution of accelerated venovenous hemofiltration (AVVH) were divided into two groups according to the dialysis dose: low-dose group [25～30ml/(kg·h)] and high-dose group [50～60ml/(kg·h)]. Treatment parameters for the first PIRRT, serum levels of urea, K+, PO4 and carbon dioxide at the beginning and end of PIRRT, estimated urea reduction rate (URR), spKt/V, and complications occurring during and after PIRRT were collected and compared between the two groups.  Results  There were no significant differences in age, sex ratio, dry body weight and hemoglobin (t=1.388, 0.459, 0.479 and 0.913 respectively, P=0.085, 0.498, 0.683 and 0.818 respectively) between low-dose group (n=31) and high-dose group (n=36). Blood flow rate of PIRRT, treatment dose and filter fraction were significantly higher in high-dose group than in low-dose group (t =14.535, 39.358 and 7.304 respectively, P＜0.001); while total net ultrafiltration had no difference between the two groups (t =1.076, P=0.857). Serum K+, PO4, and carbon dioxide were corrected to normal ranges at the end of PIRRT in both groups. URR and spKt/V were significant higher in high-dose group than in low-dose group (t=12.039 and 5.145, P<0.001). No complications were observed during and after PIRRT.  Conclusions   PIRRT can effectively correct volume overload, electrolyte abnormalities and acid-base imbalance. High-dose PIRRT is more effective than low-dose PIRRT in removal of uremic toxins, and is well tolerated by the patients and suitable to substitute for MHD.

Key words: Prolonged intermittent renal replacement therapy, Maintenance hemodialysis, Replacement therapy

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