中国血液净化

›› 2011, Vol. 10 ›› Issue (10): 556-559.doi: 10.3969/j.issn.1671-4091.2011.10.00

• 临床研究 • 上一篇    下一篇

血液灌流联合连续性血液滤过治疗脓毒血症并急性肾损伤

苏 伟 黄 昭 杨 智 王思荣 陈裕胜 于晓春 刘继云   

  1. 广州医学院附属广州市第一人民医院重症医学科
  • 收稿日期:2011-03-16 修回日期:1900-01-01 出版日期:2011-10-12 发布日期:2011-10-12
  • 通讯作者: 苏伟

Neutral resin hemoperfusion combined with continuous hemofiltration for the treatment of septic patients with acute kidney injury

U Wei, HUANG Zhao, YANG Zhi, WANG Si-rong, CHEN Yu-sheng, YU Xiao-chun, LIU Ji-yun   

  1. ICU, First Municipal People’s Hospital of Guangzhou affiliated to Guangzhou Medical College, Guangzhou, 510180, China
  • Received:2011-03-16 Revised:1900-01-01 Online:2011-10-12 Published:2011-10-12

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摘要：

目的 评价采用中性树脂的血液灌流联合连续性血液滤过治疗脓毒血症合并急性肾损伤(AKI)的临床疗效及安全性。 方法 回顾性分析广州市第一人民医院2008年至2010年脓毒症合并AKI患者78例，其中联合治疗组(L组)32例，单纯血液滤过组(S组)46例。L组先行血液灌流治疗，再行血液滤过治疗，S组仅接受血液滤过治疗。两组患者分别于治疗前及治疗第24、48、72h监测APACHEⅡ评分、氧合指数(OI)、平均动脉压(MAP)、多巴胺用量(DA)、血肌酐水平(Scr)、C反应蛋白水平(CRP)、血清白介素-6(IL-6)和白介素-10(IL-10)水平、血红蛋白浓度(Hb)和血小板计数(Plt)。观察2组以上指标的变化。 结果 L组患者均能耐受血液灌流治疗，无不良并发症发生。与治疗前比较，2组在治疗第24、48、72h时，其APACHEⅡ评分、DA、Scr、CRP及血清IL-6水平均显著下降(P＜0.05)，OI、MAP均明显上升(P＜0.05)。在治疗第24、48、72h时，L组的APACHEⅡ评分、DA、Scr、CRP及血清IL-6水平均低于S组(P＜0.05)，而OI和MAP均高于S组(P＜0.05)，但2组间IL-10水平、血红蛋白浓度及血小板计数比较均无差异(P＞0.05)。 结论 采用中性树脂的血液灌流联合连续性血液滤过可降低脓毒症患者APACHEⅡ评分、多巴胺用量、CRP及IL-6水平，提高OI及MAP，缩短患者ICU停留时间，而对30d生存率、IL-10水平、Hb浓度及Plt计数无影响。

关键词: 血液灌流, 脓毒血症, 炎症介质

Abstract:

Object To evaluate clinical effect and safety of neutral resin hemoperfusion combined with continuous hemofiltration for the treatment of septic patients with acute kidney injury (AKI). Method A total of 78 cases were enrolled in this study and were assigned into two groups. In group L (n=32), patients received hemoperfusion (HP) and then hemofiltration. In group S (n=46), patients were treated with hemofiltration. A HP session lasted for 2.5 hours, and HP carried out twice every 24 hours. APCHEⅡ score, PO2/FiO2 (OI), mean arterial pressure (MAP), dopamine dose (DA), serum creatinine (Scr), C-reactive protein (CRP), serum IL-6 and IL-10, hemoglobin (Hb) and platelet (Plt) were measured during the treatment. Result HP was well tolerated without any complication in group L. After the initiation of the treatment for 24h, 48h and 72h, APACHEⅡ score, OI, MAP, DA, Scr, CRP and IL-6 improved significantly than before treatment in the two groups (P＜0.05), but without significant changes in serum IL-10, Hb and Plt. In group L, APCHEⅡ score, OI, MAP, DA, IL-6, CRP and Scr improved better than in group S (P＜0.05). No significant differences in serum IL-10, Hb and Plt were detected between the 2 groups after the treatment. Conclusion Neutral resin hemoperfusion combined with continuous hemofiltration can improve APACHEⅡ score, PO2/FiO2 and MAP, reduce serum levels of CRP, creatinine and IL-6, but had no effects on serum IL-10, hemoglobin and platelet in septic patients with AKI

Key words: Sepsis, Inflammation mediator