连续性与间歇性血液净化治疗对脓毒症休克所致急性肾损伤患者肾脏血流动力学及糖代谢指标的影响

doi:10.3969/j.issn.1006-6233.2021.12.030

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摘要 目的: 探究连续性肾脏替代治疗(Continuous renal replacement therapy,CRRT)与间歇性血液透析(Intermittent hemodialysis,IHD)治疗对脓毒症休克所致急性肾损伤(Acutekidneyinjury,AKI)患者的治疗效果,以及对其肾脏血流动力学及糖代谢指标的影响。方法: 选取2019年3月至2021年3月在本院接受治疗的脓毒症休克所致AKI患者147例,简单随机分组分为观察组和对照组,各有患者72例、75例。其中观察组患者在常规治疗基础上采用CRRT,对照组患者采用常规联合IHD治疗,对比两组患者治疗前后相关参数。结果: 观察组患者ICU住院、尿量恢复、器官支持时间均短于对照组(P<0.05);治疗后1周,观察组患者的血清反应蛋白C(C-reactive protein,CRP)、肌酐(Serum creatinine,Scr)浓度均低于对照组(P<0.05),肾脏血流动力学指标峰值强度(Peak intensity,PI)、平均渡越时间(Meantransittime,MTT)、曲线下面积(Area under the curve,AUC)高于对照组(P<0.05),糖代谢指标空腹血糖(Fasting Blood Glucose,FBG)、餐后2h血糖(2 hours postprandial blood glucose,2PBG)低于对照组(P<0.05),观察组患者上述指标治疗前后差值均大于对照组。结论: CRRT能够显著改善脓毒症休克所致AKI机体炎症、肾脏血流动力以及糖代谢状况,可缩短患者的康复时间,值得在临床中推广应用。

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	赵敏
	李吉明
	杨宇莹
	高晓霞

关键词 ：脓毒症休克, 急性肾损伤, 连续性肾脏替代治疗, 间歇性血液透析, 肾脏血流动力, 糖代谢指标

Abstract：Objective: To explore the therapeutic effects of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) on patients with acute kidney injury (AKI) caused by septic shock, and their influence on renal hemodynamics and glucose metabolism indicators. Methods: 147 patients with AKI caused by septic shock treated in the hospital between March 2019 and March 2021 were selected as the research subjects, and were randomly divided into observation group (n=72) and control group (n=75). On the basis of conventional treatment, patients in the observation group were treated with CRRT and patients in the control group were treated with IHD. The relevant parameters were compared between the two groups before and after treatment. Results: The length of ICU stay, urine volume, recovery time, and organ support time of the observation group were shorter than those of the control group (P<0.05). 1 week after treatment, the levels of serum C-reactive protein (CRP) and serum creatinine (Scr) in the observation group were lower than those in the control group (P<0.05). The peak intensity (PI), mean transit time (MTT), and area under the curve (AUC) were higher or longer than those in the control group (P<0.05). The fasting blood glucose (FBG) and 2 hours postprandial blood glucose (2PBG) were lower than those in the control group (P<0.05). The different values of above indicators before and after treatment in the observation group were greater than those in the control group. Conclusion: CRRT can significantly improve inflammation, renal hemodynamics and glucose metabolism in patients with AKI caused by septic shock, and shorten the patients' recovery time.

Key words： Septic shock Acute kidney injury Continuous renal replacement therapy Intermittent hemodialysis Renal hemodynamics Glucose metabolism indicator

基金资助:新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目,(编号:WJWY-202017)

通讯作者: 李吉明

引用本文:

赵敏, 李吉明, 杨宇莹, 高晓霞. 连续性与间歇性血液净化治疗对脓毒症休克所致急性肾损伤患者肾脏血流动力学及糖代谢指标的影响[J]. 河北医学, 2021, 27(12): 2071-2074.
ZHAO Min, LI Jiming, YANG Yuying, et al. Effect of Continuous and Intermittent Blood Purification on Renal Hemodynamics and Glucose Metabolism Indicators in Patients with Acute Kidney Injury Caused by Septic Shock. HeBei Med, 2021, 27(12): 2071-2074.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.12.030 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I12/2071