尿毒清对重症患者急性肾损伤血液净化后肾功能部分恢复状态的治疗作用研究

谈定玉; 王兵侠; 耿平; 王云云; 孙家艳

doi:10.13201/j.issn.1009-5918.2019.09.014

尿毒清对重症患者急性肾损伤血液净化后肾功能部分恢复状态的治疗作用研究

- 苏北人民医院扬州大学临床医学院(江苏扬州,225001)
基金项目:
扬州市第三期“英才培育计划”支持项目(No:2018034)

详细信息

通讯作者: 孙家艳,E-mail:sunjiayan2007@hotmail.com

中图分类号: R692.5

收稿日期: 2019-05-15

Therapeutic effect of uremic granule on the recovery state of renal function after blood purification in severe patients with acute kidney injury

- Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, 225001, China

More Information

Corresponding author: SUN Jiayan, E-mail: sunjiayan2007@hotmail.com

Received Date: 15 May 2019

摘要

摘要: 目的: 观察尿毒清对重症患者急性肾损伤(AKI)血液净化后肾功能部分恢复状态的治疗作用。方法: 回顾性分析2016-01-2018-12期间我院重症监护病房收治的AKI患者,经治疗后停止血液净化,肾功能部分恢复,原发病和其他器官功能稳定的患者。根据停用血液净化1周内是否开始使用尿毒清颗粒,分为治疗组和对照组。观察两组治疗结束时及治疗结束2周后尿量及肾功能指标,及3个月后慢性肾病发生率。结果: 共有80例患者入选,其中治疗组39例,对照组41例。两组一般资料、病情严重度、AKI分期及血液净化时间等均差异无统计学意义。治疗结束时除血浆胱抑素C(CysC)外,治疗组血清肌酐(Scr)和尿素氮(Bun)低于对照组,而肌酐清除率(Ccr)及24 h尿量均高于对照组(均P<0.05)。治疗结束2周后治疗组Bun、Scr、Ccr、CysC及24 h尿量则均优于对照组(均P<0.01)。3个月后治疗组慢性肾病发生率显著低于对照组(15.4%vs.36.6%,P=0.031)。治疗期间两组不良反应发生率差异无统计学意义。结论: 尿毒清对重症患者急性肾损伤血液净化后肾功能部分恢复状态有良好的治疗作用,可加速肾功能的恢复,减少慢性肾病发生率。
- 尿毒清 /
- 急性肾损伤 /
- 血液净化 /
- 慢性肾病
Abstract: Objective: To explore the effect of uremic granule on the recovery state of renal function after blood purification in severe patients with acute kidney injury(AKI). Method: AKI patients in the Intensive Care Unit of our hospital from January 2016 to December 2018 were screened retrospectively. Those patients were enrolled that blood purification were no longer required, renal function partially recovered, primary disease and other organ function were stable. According to whether or not the use of urinary granules was started within one week after the blood purification, the patients were divided into the treatment group and the control group. The urine volume and renal function were observed at the end of the treatment and 2 weeks later, and the incidence of chronic kidney disease was observed three months later. Result: A total of 80 patients were enrolled, including 39 in the treatment group and 41 in the control group. There were no significant differences between the two groups in general data, severity of disease, AKI staging, and blood purification duration. At the end of treatment, except for the level of CysC, the levels of Bun and Scr in the treatment group were lower than those in the control group, and the level of Ccr and 24-hour urine volume were higher than those in the control group(all P<0.05). The levels of Bun, Scr, Ccr, CysC and 24-hour urine volume were better in the treatment group than those in the control group 2 weeks after the treatment(all P<0.01). The incidence of chronic kidney disease in the treatment group was significantly lower than that in the control group 3 months later(15.4% vs. 36.6%,P=0.031). There was no significant difference in the incidence of adverse reactions between the two groups during treatment.Conclusion: Uremic granule has a good effect on the recovery state of renal function after blood purification in severe patients with acute kidney injury.It can accelerate the recovery of renal function and reduce the incidence of chronic kidney disease.
- uremic granule /
- acute kidney injury /
- blood purification /
- chronic kidney disease

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参考文献(16)

[1]	Susantitaphong P,Cruz DN,Cerda J,et al.World incidence of AKI:a meta-analysis[J].Clin J Am Soc Nephrol,2013,8(9):1482-1493.
[2]	Sawhney S,Fraser SD.Epidemiology of AKI:Utilizing Large Databases to Determine the Burden of AKI[J].Adv Chronic Kidney Dis,2017,24(4):194-204.
[3]	Macedo E,Mehta RL.Renal Recovery after Acute Kidney Injury[J].Contrib Nephrol,2016,187:24-35.
[4]	温莉玲,陈家佳,梁红丽.尿NGAL、KIM-1联合APACHE Ⅱ评分对脓毒症急性肾损伤诊断及预后的价值[J].临床急诊杂志,2019,20(2):110-114.
[5]	Gaudry S,Hajage D,Schortgen F,et al.Initiation Strategies for Renal-Replacement Therapy in the Intensive Care Unit[J].N Engl J Med,2016,375(2):122-133.
[6]	Garabed E,Norbert L,Kai-Uwe E,et al.KDIGO clinical practice guideline for acute kidney injury[J].Kidney Int,2012,2(2):140-140.
[7]	Meersch M.Acute Kidney Injury,Chronic Kidney Disease,and Mortality:Understanding the Association[J].Anesth Analg,2019,128(5):841-843.
[8]	Rimes-Stigare C,Frumento P,Bottai M,et al.Evolution of chronic renal impairment and long-term mortality after de novo acute kidney injury in the critically ill,a Swedish multi-centre cohort study[J].Crit Care,2015,19(6):221.
[9]	Coca SG,Singanamala S,Parikh CR.Chronic kidney disease after acute kidney injury:a systematic review and meta-analysis[J].Kidney Int,2012,81(5):442-448.
[10]	Chawla LS,Eggers PW,Star RA,et al.Acute kidney injury and chronic kidney disease as interconnected syndromes[J].N Engl J Med,2014,371(1):58-66.
[11]	庄振起,周广宇,尹敏,等.尿毒清治疗慢性肾脏病的研究进展[J].中国老年学杂志,2016,36(15):3841-3843.
[12]	丁文飞,钟爱民,王金艳,等.尿毒清颗粒对造影剂肾病的实验研究[J].中国中西医结合肾病杂志,2014,15(7):612-615.
[13]	李雪芹,黄斐斐,周峥法.尿毒清治疗甘露醇所致急性肾功能衰竭36例[J].实用医学杂志,2011,27(1):129-131.
[14]	张玲,姚萍,刘九惠.尿毒清联合凯时治疗急性肾衰的疗效观察[J].齐齐哈尔医学院学报,2009,30(18):2251-2252.
[15]	戴绍文,刘玉华,叶惠成.尿毒清颗粒联合前列地尔对慢性肾功能不全急性加重患者治疗效果观察[J].中医临床研究,2017,9(24):67-69.
[16]	吴万里,潘朝锌,吴显儒,等.尿毒清颗粒预防对比剂肾病的临床研究[J].中国中西医结合肾病杂志,2010,11(1):59-60.