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目的:探讨不同血液净化方式在治疗脓毒症致急性肾损伤(AKI)患者中的临床疗效情况。方法:选择2014-01-2016-01在我院就诊的84例脓毒症致AKI患者,按照随机原则分为2组,其中42例采用连续性肾脏替代治疗(CRRT组),另42例患者采用持续低效血液透析联合血液灌流治疗(联合组),对比2组APACHEⅡ评分、MAP、DA用量、Scr、Hb、Alb、WBC以及相关炎性因子变化水平,同时对患者的并发症发生率、30d存活率和ICU住院时间进行统计对比。结果:2组患者治疗前的APACHEⅡ评分、MAP以及各项指标比较差异无统计学意义,而在治疗后,2组患者的APACHEⅡ、MAP、DA、Scr、WBC、IL-6、IL-10、TNF-α比较差异有统计学意义(P<0.05)。2组患者在治疗后均未出现明显并发症。此外,CRRT组患者存活率42.86%(18/42)明显低于联合组78.57%,差异有统计学意义(P<0.05)。且联合组患者在ICU住院时间要明显短于CRRT组,差异有统计学意义(P<0.05)。结论:相对于CRRT,持续低效血液透析联合血流灌注对脓毒症致AKI患者治疗效果较高,可能具有控制炎症、改善肾功能的效果,一定程度上降低了患者病死率,但具体疗效有待进一步大样本多中心研究进行验证。
Objective: To investigate the clinical efficacy of different methods of blood purification in the treatment of patients with acute kidney injury (AKI) caused by sepsis. Methods: A total of 84 patients with sepsis-induced AKI who were treated in our hospital from January 2014 to June 2016 were selected and randomly divided into two groups. Among them, 42 patients were treated with continuous renal replacement therapy (CRRT) and 42 patients APACHEⅡscore, MAP, DA dosage, Scr, Hb, Alb, WBC and related inflammatory factors were compared between the two groups by continuous low efficiency hemodialysis combined with hemoperfusion (combination group). The incidence of complication, 30d survival and ICU hospitalization for statistical comparison. Results: There was no significant difference in APACHEⅡscore, MAP and other indexes between the two groups before treatment, but APACHE Ⅱ, MAP, DA, Scr, WBC, IL-6, IL- The difference of TNF-α was statistically significant (P <0.05). No significant complication occurred in the two groups after treatment. In addition, the survival rate of patients in CRRT group was 42.86% (18/42), which was significantly lower than that in combined group (78.57%), the difference was statistically significant (P <0.05). Patients in the combined group had significantly shorter hospital stay in the ICU than in the CRRT group (P <0.05). CONCLUSIONS: Compared with CRRT, continuous low inefficient hemodialysis combined with perfusion has a higher therapeutic effect on patients with AKI induced by sepsis, which may have the effect of controlling inflammation and improving renal function, and to a certain extent reduce the mortality of patients, but the specific curative effect To be further large sample multi-center study to verify.