CAJ | 학술논문

目的探讨持续低效每日透析(SLEDD)治疗急性肾损伤的疗效和安全性.方法选择住院并接受血液净化治疗的急性肾损伤(AKI)患者76例,分为SLEDD、间歇性血液透析(IHD)和持续静静脉血液滤过(CVVH)三组,其中SLEDD组21例,IHD组27例,CVVH组28例.比较三组患者接受血液净化前的基础病情,采集3种血液净化治疗模式对急性肾损伤患者血流动力学,溶质清除,水、电解质和酸碱平衡,疾病转归影响和抗凝剂用量的指标进行统计学处理.结果三组患者基础病情比较差异无统计学意义(P＞0.05)；SLEDD、CVVH组血流动力学不稳定的发生率比较差异无统计学意义(P＞0.05),SLEDD、IHD组比较差异有统计学意义(P＜0.01),IHD组因血流动力学不稳定引起的单次透析中断率为33.27％；三组尿毒症毒素清除、电解质(除血K+差值SLEDD较CVVH组下降)及酸碱差异均无统计学意义(P＞0.05),日液体出入量、超滤量SLEDD组较IHD组增多(P＜0.05),抗凝剂量SLEDD组较CVVH组减少(P＜0.01)；存活率及肾功能恢复时间SLEDD组优于IHD组.结论 SLEDD比较IHD治疗急性肾损伤血流动力学相对稳定、病死率低、溶质清除及超滤充分；比较CVVH血流动力学、溶质清除及超滤量差异无统计学意义,抗凝剂用量减少.
목적 탐토지속저효매일투석(SLEDD)치료급성신손상적료효화안전성.방법 선택주원병접수혈액정화치료적급성신손상(AKI)환자76례,분위SLEDD、간헐성혈액투석(IHD)화지속정정맥혈액려과(CVVH)삼조,기중SLEDD조21례,IHD조27례,CVVH조28례.비교삼조환자접수혈액정화전적기출병정,채집3충혈액정화치료모식대급성신손상환자혈류동역학,용질청제,수、전해질화산감평형,질병전귀영향화항응제용량적지표진행통계학처리.결과 삼조환자기출병정비교차이무통계학의의(P＞0.05)；SLEDD、CVVH조혈류동역학불은정적발생솔비교차이무통계학의의(P＞0.05),SLEDD、IHD조비교차이유통계학의의(P＜0.01),IHD조인혈류동역학불은정인기적단차투석중단솔위33.27％；삼조뇨독증독소청제、전해질(제혈K+차치SLEDD교CVVH조하강)급산감차이균무통계학의의(P＞0.05),일액체출입량、초려량SLEDD조교IHD조증다(P＜0.05),항응제량SLEDD조교CVVH조감소(P＜0.01)；존활솔급신공능회복시간SLEDD조우우IHD조.결론 SLEDD비교IHD치료급성신손상혈류동역학상대은정、병사솔저、용질청제급초려충분；비교CVVH혈류동역학、용질청제급초려량차이무통계학의의,항응제용량감소.
Objective To investigate the effectiveness and safety of sustained low-efficiency daily dialysis(SLEDD) in patients with acute kidney injury (AKI).Methods Seventy-six hospitalized patients with acute kidney injury who requiring blood purification were selected.All patients were divided into three groups according to blood purification methods,21 patients in group SLEDD (sustained low-efficiency daily dialysis),27 patients in group IHD(intermittent homodialysis),28 patients in group CVVH(continuous veno-venous hemofiltration).Data included primary disease,gender,age,APACHEII (acute physiology and chronic health evaluation Ⅱ) score,number of dysfunction organs,AKI classifcation,time from onse of AKI to receiving blood purification were observed before blood purification.The indices of hemodynamics,solute clearance,water-electrolyte and acid-base metabolism,prognosis of disease and anticoagulant dosage were collected,then the data be treated statistically.Results The patient' s condition had no statistically significant difference (P ＞ 0.05).There were no difference or significant difference between group SLEDD and CVVH or group SLEDD (P ＞ 0.05),and IHD in rates of hemodynamic instability (P ＜ 0.01),and the exiting rates in group IHD were 33.27％ for hemodynamic deterioration,while in groups SLEDD and CVVH no exit.Also there were no difference about solute clearance,water-electrolyte and acid-base metabolism among the three groups,but anticoagulant dosage in group SLEDD was less than that in group CVVH.About survival rate and renal functional restoration,group SLEDD was better than group IHD.Conclusions SLEDD had some advantage in haemodynamic stabilization,low mortality rate,sufficient solute clearance and ultrafiltration than IHD,also some forte less anticoagulant dosage than CVVH.