CAJ | 학술논문

目的：比较持续低效血液透析（ sustained low －efficiency dialysis ， SLED）联合血液灌流（hemoperfusion， HP）与连续性血液净化（continuous blood purification， CBP）在脓毒症急性肾损伤（ AKI）患者中的治疗效果。方法52例脓毒症AKI患者，根据行血液净化方式不同分为SLED联合HP组（n＝25）及CBP组（n＝27），比较两组治疗前后平均动脉压（MAP）、氧合指数（PaO2／FiO2，OI）、血肌酐（Scr）、肿瘤坏死因子－α（TNF－α）、白细胞介素－6（IL－6）及急性生理学与慢性健康状况评分系统Ⅱ（ acute physiology and chronic health evaluation ， APACHEⅡ）评分、ICU住院时间及90 d死亡率等指标。结果两组治疗后第1、2、3、7天Scr、TNF－α、IL－6水平较治疗前均明显下降（P＜0．05），第2、3、7天APACHEⅡ评分较治疗前明显下降（P＜0．05），OI、MAP明显上升（ P ＜0．05）。 SLED 联合 HP 组在治疗后第2、3、7天的 Scr、TNF －α、IL －6、APACHEⅡ评分均低于CBP组，OI及MAP均高于CBP组（P＜0．05），ICU住院时间短于CBP组，但两组90 d死亡率差异无统计学意义（P＞0．05）。结论 SLED联合HP治疗脓毒症AKI在毒素及炎症介质清除方面优于CBP组，能缩短ICU住院时间，但90 d死亡率与CBP组比较差异无统计学意义，提示临床预后方面SLED联合HP治疗可能并不优于CBP组。
목적：비교지속저효혈액투석（ sustained low －efficiency dialysis ， SLED）연합혈액관류（hemoperfusion， HP）여련속성혈액정화（continuous blood purification， CBP）재농독증급성신손상（ AKI）환자중적치료효과。방법52례농독증AKI환자，근거행혈액정화방식불동분위SLED연합HP조（n＝25）급CBP조（n＝27），비교량조치료전후평균동맥압（MAP）、양합지수（PaO2／FiO2，OI）、혈기항（Scr）、종류배사인자－α（TNF－α）、백세포개소－6（IL－6）급급성생이학여만성건강상황평분계통Ⅱ（ acute physiology and chronic health evaluation ， APACHEⅡ）평분、ICU주원시간급90 d사망솔등지표。결과량조치료후제1、2、3、7천Scr、TNF－α、IL－6수평교치료전균명현하강（P＜0．05），제2、3、7천APACHEⅡ평분교치료전명현하강（P＜0．05），OI、MAP명현상승（ P ＜0．05）。 SLED 연합 HP 조재치료후제2、3、7천적 Scr、TNF －α、IL －6、APACHEⅡ평분균저우CBP조，OI급MAP균고우CBP조（P＜0．05），ICU주원시간단우CBP조，단량조90 d사망솔차이무통계학의의（P＞0．05）。결론 SLED연합HP치료농독증AKI재독소급염증개질청제방면우우CBP조，능축단ICU주원시간，단90 d사망솔여CBP조비교차이무통계학의의，제시림상예후방면SLED연합HP치료가능병불우우CBP조。
Ob jective To compare the therapeutic effect between sustained low -efficiency dialysis (SLED) combined hemoperfusion (HP) and continuous blood purification (CBP) in patients with septic acute kidney injury ( AKI) .Methods Fifty-two patients during January 2010 and January 2013 with septic AKI were randomly assigned to receive SLED combined HP group ( n=25 ) and CBP group ( n =27 ) according to the different treatment ways . The mean arterial pressure ( MAP ) , oxygenation index (OI), serum creatinine (Scr), tumor necrosis factor-α(TNF-α), interleukin-6 ( IL-6) and acute physiology and chronic health evaluationⅡ ( APACHEⅡ) score, ICU stay, 90-day mortality were compared before and after treatment of two groups .Results The levels of Scr , TNF-α, IL-6, APACHEⅡ score after treatment of 2, 3, 7 -day decreased significantly in SLED combined HP group compared with CBP group (P<0.05), but OI and MAP increased significantly (P<0.05).There were significant differences in ICU stay between two groups (P<0.05), but there were no significant differences in 90 -day mortality between two groups ( P>0.05 ) .Conclusion SLED combined HP treatment may be superior to CBP treatment in clearing toxins and inflammatory mediators, and can shorten the ICU stay , but may not be superior to CBP in improving clinical outcomes.