血液灌流联合连续性静脉静脉血液滤过治疗脓毒血症合并急性肾损伤的疗效分析

目的评估传统治疗基础上血液灌流(Hemoperfusion,HP)联合连续性静脉静脉血液滤过(ContinuousVeno-Venous Hemofiltration,CVVH)与单独使用CVVH治疗脓毒血症合并急性肾损伤的临床疗效。方法采用前瞻性随机对照实验方式于2010年7月～2011年11月纳入脓毒血症合并急性肾损伤(Acute Kidney Injury,AKI)患者,符合纳入标准后随机分配至HP联合CVVH的实验组及单独使用CVVH的对照组。实验组将血灌器串联于滤器后同时进行2h治疗后拆除血灌器继续行CVVH治疗,24h后再次行血液灌流,重复进行至少3次。两组患者分别于治疗前(0h)及治疗第72h采血检测TNF-α、IL-1、IL-6和IL-10浓度。每日记录生命体征、血红蛋白浓度(Hb)和血小板计数(Plt)。比较两组60天生存率、ICU住院时间和肾功能恢复时间等指标。结果两组共纳入患者45例,实验组24例,对照组21例。实验组60天存活率为13/24(54.2%),对照组60天存活率为10/21(47.6%),两组比较无统计学差异(P>0.05)。存活患者ICU住院天数两组无显著差异[(18.8±10.5)d vs.(28.8±10.2)d,P=0.392]。存活患者肾功能恢复天数,实验组显著低于对照组[(7.4±5.4)d vs.(25.5±15.7)d,P=0.019]。治疗前两组血TNF-α、IL-1、IL-6和IL-10浓度无显著差异,治疗第72h时,实验组血清TNF-α、IL-1水平显著下降,对照组患者血清IL-1水平显著下降。两组患者均无不良事件发生。结论与单独CVVH相比较,HP联合CVVH能更加有效的清除炎症介质,有助于肾功能的早期恢复。

Hemoperfusion plus continuous veno-venous hemofiltration for patients with sepsis and acute kidney injury

Objective To evaluate the therapeutic effect of continuous veno-venous hemofiltration(CVVH) plus hemoperfusion(HP) for patients with sepsis and acute kidney injury(AKI).Methods We prospectively enrolled patients with sepsis and AKI admitted in our hospital between July 2010 and October 2011.Patients were randomly assigned to CVVH plus HP group(study group) or CVVH group(control group) when confirmed to meet the inclusion criteria.Patients in study group received HP treatment 2 hours a time every 24 hours with hemoperfutor installed after the hemofilter,and HP were performed at least 3 times for each patient.CVVH treatment was performed continuously in both groups and adjusted according to patients’ clinical conditions 3 days after inclusion.Other conventional treatments were given by clinical guideline for sepsis.Blood samples of all patients were withdrawed at the beginning of treatment(0h) and at 72h to test the plasma level of TNF-α,IL-1,IL-6,IL-10.Vital signs and other laboratory tests were recorded.60-day survival rate,duration of ICU stay and time needed for renal recovery were evaluated.Results 25 patients were enrolled,with 14 patients in study group and 11 patients in control group.60-day survival rate was 6/14(42.9% in study group and 4/11(36.4%)in control group respectively,no significant difference was found between two groups.For survivors,duration of ICU stay had no significant difference between groups(18.8±10.5d vs.28.8±10.2d,P=0.392).Time needed for renal recovery for survivors in study group was 7.4±5.4d,which is significantly shorter than that of control group(25.5±15.7d,P=0.019).Plasma level of TNF-α,IL-1,IL-6 and IL-10 at 0h had no significant difference between groups.At 72h,plasma level of TNF-αand IL-1 decreased significantly in study group and IL-1 level of control group also showed significant decrease.No reverse effect was found in both groups.Conclusion Compared with CVVH solely,CVVH plus HP may be more effective to remove plasma inflammatory factors and could reduce the time needed for renal recovery for patients with sepsis and AKI.