持续低效血液透析滤过和持续静脉静脉血液滤过对蜂蜇伤后急性肾损伤的疗效比较

摘要

Objective To evaluate the effect of sustained low-efficient hemodiafiltration (SLEDF) on acute kidney injury (AKI) patients following wasp stings. Methods Clinical data of the 31 patients with phase HI AKI following wasp stings were retrospectively analyzed. These patients were treated with SLEDF (SLEDF group, n=17) or continuous veno-venous hemofiltration (CVVH) (CVVH group, n=14). General conditions of the patients, mortality, time to reach polyuria stage, time to recover from higher serum creatinine, score of acute physiology and chronic health evaluation (APACHE II), serum level of creatinine at the 3rd and 7th day after treatment, adverse effects of SLEDF and CVVH, and expenses for blood purification were compared between the two groups. Results There were no significant differences in general conditions of the patients, mortality (11.7% vs 7.1%), time to reach polyuria stage (22.2 ± 3.2 days vs. 20.2 ± 4.1 days), time to recover from higher serum creatinine (39.3 ± 7.9 days vs. 34.1 ± 7.7 days), and adverse effects between the two groups. There were also no significant differences in APACHE II scores and serum creatinine levels before treatment, at 3rd day and 7th day between the two groups. Blood purification expense was lower in SLEDF group than in CVVH group (P ＜ 0.01). Conclusion SLEDF and CVVH have similar effects in outcomes, recovery of renal function, relief of early disease symptoms, and stabilization of hemodynamics in acute kidney injury (AKI) patients following wasp stings. However, the expense is lower in SLEDF than in CVVH.%目的 评价持续低效血液透析滤过(sustained low-efficiency diafiltration,SLEDF)对蜂蜇伤后急性肾损伤(acute kidney injury,AKI)的治疗价值. 方法 回顾性分析31例蜂蜇伤后AKI Ⅲ期患者临床资料,分为SLEDF组17例和持续静脉静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组14例.比较两组患者的一般情况、死亡率、进入多尿期的时间、血肌酐(Scr)恢复正常的时间、治疗后第3d和第7d的急性生理学与慢性健康状况评分(APACHE) Ⅱ以及Scr水平、SLEDF 和CVVH相关不良反应以及血液净化治疗的费用. 结果 治疗前两组患者一般情况的差异没有统计学意义,SLEDF组和CVVH组的死亡率(11.7％比7.1％)、进入多尿期的时间[(22.2±3.2)d比(20.2±4.1)d]、Scr恢复正常的时间[(39.3±7.9)d比(34.1±7.7)d]以及SLEDF和CVVH相关不良反应的差异没有统计学意义(P＞0.05)；在治疗前、治疗第3d和治疗第7d,SLEDF组和CVVH组的APACHE Ⅱ以及Scr的差异均无统计学意义(P＞0.05); SLEDF组血液净化治疗费用低于CVVH组(P＜0.01).结论 SLEDF 在改善蜂蜇伤后AKI Ⅲ期患者的预后、促进肾功能恢复以及缓解早期病情等方面与CVVH疗效相当,具有稳定的血流动力学,医疗费用较CVVH低,值得推广.