日间静静脉血液透析滤过在脓毒血症合并急性肾损伤的应用

目的研究日间静静脉血液透析滤过(continuous venovenous hemodiafiltration,CVVHDF)在脓毒血症合并急性肾损伤(acute kidney injury,AKI)患者治疗中的应用和影响预后的因素.方法观察分析宁夏医科大学总医院肾脏内科采用日间静静脉血液透析滤过以置换流量35～40ml/(kg·h)、透析液流量1500～2000 ml/h为方案救治的16例脓毒血症合并急性肾损伤患者的资料,评估临床特点和影响预后的因素.结果7例(43.8%)患者度过疾病的急性期(存活组),APACHE Ⅱ评分为(25.4±6.7);9例(56.2%)患者在急性期死亡(死亡组),APACHE Ⅱ评分为(34.4±4.3).对2组患者的临床资料、生化指标、机械通气状况、脏器损伤的特点、疾病的严重程度等因素进行分析,发现2组患者应用CVVHDF治疗前的机械通气状况、脏器衰竭数量、血钠、尿量之间差异有统计学意义(P＜0.05).同时,死亡组APACHE Ⅱ评分(急性生理学与慢性健康状况评分Ⅱ)高于存活组,代谢性酸中毒严重程度明显.结论日间CVVHDF可降低脓毒血症合并急性肾损伤患者的死亡率.脓毒血症患者的预后受患者是否存在机械通气、脏器衰竭数量、血钠水平、代谢性酸中毒程度及APACHE Ⅱ分值的影响.

Application of daytime continuous veno-venous hemodiafiltration for the treatment of sepsis with acute kidney injury patients

Objective To evaluate the clinical efficacy of continuous veno-venous hemodiafiltration (CVVHDF) in treating critically ill patients with sepsis and acute renal injury. Methods The clinical features and factors affecting prognosis were retrospectively analyzed in 16 critically ill patients with sepsis and acute renal injury who received daytime CVVHDF in this hospital from Jan. 2010 to Feb. 2011. Patients received this treatment schedule with CVVHDF of 35-40 ml per kilogram of body weight per hour and 1500-...