本文選題：腎替代療法 + 膿毒癥　； 參考：《中國全科醫(yī)學》2016年18期

【摘要】：目的觀察不同連續(xù)性腎臟替代治療(CRRT)模式及其劑量對膿毒癥合并急性腎損傷(AKI)患者的溶質清除效果。方法選取2013年12月—2014年12月河北醫(yī)科大學第四醫(yī)院重癥醫(yī)學科(ICU)收治的符合納入與排除標準的膿毒癥合并AKI患者23例為研究對象。采用隨機數(shù)字表法將患者分為連續(xù)性靜脈-靜脈血液濾過(CVVH)組(14例)和連續(xù)性靜脈-靜脈血液透析濾過(CVVHDF)組(9例)。兩組均使用100%前稀釋,處方廢液劑量(K_p)設置為40.00 ml·kg~(-1)·h~(-1),其中CVVHDF組置換液流速與透析液流速相同。抗凝方案的選擇依據(jù)患者凝血功能由臨床醫(yī)師決定。收集患者一般資料,計算CRRT劑量〔包括K_p、校正劑量(K_(pc))、交付劑量(K_d)、實際溶質清除劑量(K)〕。記錄患者處方CRRT時間、實際CRRT時間、機械通氣時間、住ICU時間、總住院時間、28 d病死率。結果兩組患者Kp比較,差異無統(tǒng)計學意義(P0.05);CVVHDF組患者K_(pc)、K_d、K_(Cr)大于CVVH組(P0.05)。CVVH組、CVVHDF組患者K_(pc)、Kd、KCr小于K_p,K_d、K_(Cr)小于K_(pc),K_(Cr)小于K_d(P0.05)。CVVHDF組患者Kβ2-M、KIL-6、KIL-8小于CVVH組(P0.05)。兩組患者處方CRRT時間、實際CRRT時間、機械通氣時間、住ICU時間、總住院時間、28 d病死率比較,差異無統(tǒng)計學意義(P0.05)。結論不同CRRT模式下CRRT劑量均被高估;Kp相同的情況下,不同CRRT模式均能有效清除炎性因子,且患者預后無差異,但CVVHDF對小分子溶質的清除率優(yōu)于CVVH,而CVVH對中大分子溶質的清除率優(yōu)于CVVHDF。
[Abstract]:Objective to observe the solute clearance in patients with sepsis complicated with acute renal injury (AKI) by different continuous renal replacement therapy (CRRT) model and its dosage. Methods from December 2013 to December 2014, 23 patients with sepsis complicated with AKI who were admitted to the Department of intensive Medicine of the fourth Hospital of Hebei Medical University were selected as the study objects. The patients were divided into continuous veno-venous hemofiltration (CVVH) group (n = 14) and continuous veno-venous hemodiafiltration (CVV HDF) group (n = 9). Both groups were diluted before 100% and the dosage of prescription waste liquid was set at 40.00 ml / kg ~ (-1) 路h ~ (-1). The flow rate of replacement solution in CVVHDF group was the same as that of dialysate. The choice of anticoagulant regimen is determined by the clinician according to the coagulation function of the patient. The general data of patients were collected and the dose of CRRT (including Kapp) was calculated. The prescription CRRT time, actual CRRT time, mechanical ventilation time, residence time of ICU, total hospitalization time of 28 days were recorded. Results there was no significant difference in Kp between the two groups. There was no significant difference between the two groups. There was no significant difference in CRRT time, actual CRRT time, mechanical ventilation time, ICU residence time, total hospitalization time and fatality rate between the two groups (P 0.05). Conclusion when the dose of CRRT is overestimated in different CRRT models, different CRRT models can effectively remove inflammatory factors, and there is no difference in the prognosis of the patients. However, the clearance rate of CVVHDF to small molecule solute was better than that of CVVH, while that of CVVH to medium and macromolecular solute was better than that of CVVHDF.
【作者單位】： 河北醫(yī)科大學第四醫(yī)院ICU;
【基金】：河北省科技支撐計劃項目(14277796D)
【分類號】：R459.7

【參考文獻】

相關期刊論文 前2條

1 孫治平;孫伏喜;牛常明;沈霞;葉紅;曹紅娣;;連續(xù)性腎臟替代治療及其液體負平衡可改善膿毒性急性腎損傷患者的腎功能和預后[J];中華危重病急救醫(yī)學;2015年05期

2 林欽漢;張明;陳軍;周海波;黃國棟;;早期連續(xù)性腎臟替代治療對嚴重膿毒癥患者的治療意義[J];中國中西醫(yī)結合急救雜志;2014年01期

【共引文獻】

相關期刊論文 前10條

1 劉金濤;羅海麗;袁通梅;陳若冰;吳俊成;;連續(xù)性腎臟替代治療對老年膿毒癥患者腸功能、免疫功能和預后轉歸的影響[J];山東醫(yī)藥;2017年10期

2 謝偉武;;CRRT在MODS急性腎損傷患者中應用的時機探討[J];內科;2017年01期

3 安克潤;曹f ;冷彥飛;羅小蘭;王蓉;袁建紅;尹賢;秦超芬;;CRRT治療膿毒血癥合并AKI患者的臨床觀察及護理[J];西部醫(yī)學;2016年12期

4 王紹紅;劉金濤;袁通梅;羅海麗;吳丹;沈鋒;;CRRT在老年膿毒癥患者治療中的應用效果及其對血清炎性因子水平的影響[J];山東醫(yī)藥;2016年42期

5 劉丹丹;陳立華;李廣罡;王敏;孫s，

本文編號：1817865