连续性与间歇性肾脏替代治疗对多器官功能障碍综合征的临床疗效比较-现代医学

连续性与间歇性肾脏替代治疗对多器官功能障碍综合征的临床疗效比较

单位：1. 钦州市第一人民医院重症医学科, 广西钦州 535000;
2. 钦州市第一人民医院肾内科, 广西钦州 535000

分类号：R692.5

出版年·卷·期（页码）：2020·48·第一期（65-70）

摘要：

目的： 比较连续性与间歇性肾脏替代治疗（renal replacement therapy，RRT）对多器官功能障碍综合征的临床疗效。方法： 从2015年10月到2018年3月，选择本院重症监护室（ICU）接受RRT治疗的多器官功能障碍综合征患者作为研究对象。患者随机接受连续性RRT（n=44）与间歇性RRT（n=46）。主要观察指标是RRT结束后28 d的生存率。次要结果指标包括28 d和60 d的院内死亡率，ICU的住院天数，停用RRT的时间，血管加压药/机械通气总天数，疾病严重程度。方法： 两组在 RRT后28 d生存率，以及28 d、60 d和全因死亡率均无显著差异（P>0.05），并且两组在ICU住院到死亡的时间、ICU住院时间、住院时间、死亡原因、RRT治疗时间、无透析时间、机械通气总时间均无显著差异（P>0.05）。两组之间大多数不良事件的发生率没有显著差异（P>0.05）。与连续性RRT组相比，间歇性RRT组较少发生低体温事件（18.2% vs. 4.3%，P<0.05）。方法： 在多器官功能障碍综合征的急性肾衰竭患者中，采用连续性RRT或间歇性RRT具有相同的临床疗效。

Objective: To compare the clinical effects of continuous and intermittent renal replacement therapy (RRT) on multiple organ dysfunction syndrome. Methods: From October 2015 to March 2018, patients with multiple organ dysfunction syndrome treated with RRT in our intensive care unit (ICU) were selected as the study subjects. Patients were randomized to receive either CRRT (n=44) or IRRT (n=46). The primary outcome measure was survival 28 days after the end of RRT. Secondary outcome measures included 28-day-, 60-day-, all cause intrahospital mortality, days until death (on ICU), days of ICU/hospital stay, days of RRT/dialysis-free days, total days on vasopressors/mechanical ventilation, and course of disease severity. Results: Survival at 28 days after RRT, 28-day-, 60-day-and all-cause intrahospital mortality rates were not different between the two groups (P> 0.05).There were no significant differences in the days until death (on ICU), ICU hospitalization time, hospitalization time, the cause of death, RRT treatment time, dialysis-free time and the total duration of mechanical ventilation between the two groups (P> 0.05). There was no significant difference in the incidence of most adverse events between the two groups (P> 0.05). Compared with the CRRT group, the IRRT group had fewer hypothermia events (18.2% vs. 4.3%, P<0.05). Conclusion: In patients with acute renal failure as part of multiple-organ dysfunction syndrome, CRRT or IRRT has the same clinical efficacy.

参考文献：

[1] 韩建伟,刘京涛,马朋林.肾脏替代治疗时机对急性肾损伤患者病死率的影响——两项随机对照研究的再分析[J].中华内科杂志,2018,57(5):355-357.
[2] NASH D M,PRZECH S,WALD R,et al.Systematic review and meta-analysis of renal replacement therapy modalities for acute kidney injury in the intensive care unit[J].J Crit Care,2017,41:138-144.
[3] TATUM J M,BARMPARAS G,KO A,et al.Analysis of survival after initiation of continuous renal replacement therapy in a surgical intensive care unit[J].JAMA Surg,2017,152(10):938-943.
[4] SCHEFOLD J C,HAEHLING S V,PSCHOWSKI R,et al.The effect of continuous versus intermittent renal replacement therapy on the outcome of critically ill patients with acute renal failure (CONVINT):a prospective randomized controlled trial[J].Crit Care,2014,18(1):R11.
[5] 刘强,许琳.连续性肾脏替代疗法与间歇性血液透析治疗重症急性肾功能衰竭的临床效果对比[J].华西医学,2017,32(3):392-394.
[6] TRUCHE A S,DARMON M,BAILLY S,et al.Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients:impact on mortality and renal recovery[J].Intensive Care Med,2016,42(9):1408-1417.
[7] WANG A Y,BELLOMO R.Renal replacement therapy in the ICU:intermittent hemodialysis,sustained low-efficiency dialysis or continuous renal replacement therapy?[J].Curr Opin Crit Care,2018,24(6):437-442.
[8] BAGSHAW S M,GIBNEY R T N,KRUGER P,et al.The effect of low-dose furosemide in critically ill patients with early acute kidney injury:a pilot randomized blinded controlled trial (the SPARK study)[J].J Crit Care,2017,42(4):138-146.
[9] OLIVERO J J.Continuous venous-venous-hemodialysis versus intermittent-hemodialysis in critically ill patients[J].Methodist Debakey Cardiovascular Journal,2018,14(2):153-155.
[10] KONING M V,ROEST A A,VERVLOET M G,et al.Determinants of outcome in non-septic critically ill patients with acute kidney injury on continuous venovenous hemofiltration[J].Nephron Extra,2011,1(1):91-100.
[11] INVESTIGATORS R S.Intensity of continuous renal-replacement therapy in critically ill patients[J].N Engl J Med,2016,361(17):1627-1638.
[12] 李强,苗世敏.连续性肾脏替代治疗与间歇性血液透析治疗在急性肾衰竭中的治疗效果比较[J].中国中西医结合肾病杂志,2018,19(1):70-72.
[13] BRAIN M J,ROODENBURG O S,MCNEIL J.Comparison of pre-filter and post-filter ionised calcium monitoring in continuous veno-venous hemodiafiltration (CVVHD-F) with citrate anti-coagulation[J].Plos One,2017,12(12):e0189745.
[14] 张海民,彭波,王光春,等.早期持续性肾脏替代治疗对尿源性脓毒血症预后的影响[J].中华泌尿外科杂志,2018,39(s1):50-53.
[15] 孟丽君,刘微丽.不同时机连续性肾脏替代治疗对急性呼吸窘迫综合征的影响[J].中国急救医学,2018,38(1):67-71.

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