贾建成;孙东辉;夏冬雪;王彦彬;

• 1:驻马店市第一人民医院

摘要(Abstract)：

目的探讨不同透析方法对颅脑外伤合并急性肾衰竭(ARF)患者预后的影响。方法选取颅脑外伤合并ARF患者97例,按透析方式分为间歇性血液透析组(IHD组,n=41)及连续肾脏替代治疗组(CRRT组,n=56),比较2组透析治疗前后尿素氮(BUN)、血肌酐(Scr)、电解质(血钾、血钠、血氯)水平及白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)等因子的变化;比较2组脑脊液压力及血浆渗透压变化;检测透析前后血红蛋白(Hb)、白蛋白(ALB)、瘦素(Leptin)、体重指数(BMI)变化;统计透析相关并发症发生率及随访1 a存活率。结果透析2周后CRRT组BUN、Scr、血钾低于IHD组,血钠、血氯高于IHD组(P<0.05),IL-1、IL-6、TNF-α、hs-CRP低于IHD组(P<0.05);CRRT组透析前后脑脊液压力及血浆渗透压差值低于IHD组(P<0.05);CRRT组低血压发生率低于IHD组,1 a存活率高于IHD组(P<0.05)。结论 CRRT透析治疗颅脑外伤合并ARF整体价值优于IHD,可减少患者脑血流波动,减轻炎症反应,保护肾功能,减少并发症,提高近期存活率。

关键词(KeyWords)： 颅脑外伤;急性肾衰竭;连续肾脏替代;间歇性血液透析;肾功能

Abstract:

Keywords:

基金项目(Foundation): 2019年河南省医学科技攻关计划共建项目(编号:LHGJ20191455)

作者(Authors): 贾建成;孙东辉;夏冬雪;王彦彬;

参考文献(References)：

• [1] CRAWFORD T C,MAGRUDER J T,GRIMM J C,et al.Renal Failure After Cardiac Operations:Not All Acute Kidney Injury Is the Same[J].Ann Thorac Surg,2017,104(3):760-766.DOI:10.1016/j.athoracsur.2017.01.019.
• [2] DE CORTE W,DHONDT A,VANHOLDER R,et al.Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy:a prospective cohort study[J].Crit Care,2016,20(1):256-259.DOI:10.1186/s13054-016-1409-z.
• [3] BESNARD N,SERVEAUX M,MACHADO S,et al.Electrolytes-Enriched Hemodiafiltration Solutions for Continuous Renal Replacement Therapy in Acute Kidney Injury:A Crossover Study[J].Blood Purif,2016,42(1):18-26.DOI:10.1159/000444248.
• [4] FERNáNDEZ S,SANTIAGO M J,GONZáLEZ R,et al.Hemodynamic impact of the connection to continuous renal replacement therapy in critically ill children.[J].Pediatr Nephrol,2019,34(1):163-168.DOI:10.1007/s00467-018-4047-7.
• [5] OH H J,KIM M H,AHN J Y,et al.Can early initiation of continuous renal replacement therapy improve patient survival with septic acute kidney injury when enrolled in early goal-directed therapy?[J].J Crit Care,2016,35:51-56.DOI:10.1016/j.jcrc.2016.04.032.
• [6] 杜静,王训,高宗良.脑出血合并维持性血液透析24例临床分析[J].中国实用神经疾病杂志,2018,21(14):1572-1576.DOI:10.12083/SYSJ.2018.14.364.
• [7] PARK J Y,AN J N,JHEE J H,et al.Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury:a multicenter prospective cohort study[J].Crit Care,2016,20(1):260.DOI:10.1186/s13054-016-1437-8.
• [8] HARROIS A,SOYER B,GAUSS T,et al.Prevalence and risk factors for acute kidney injury among trauma patients:a multicenter cohort study.[J].Crit Care,2018,22(1):344.DOI:10.1186/s13054-018-2265-9.
• [9] EL-SISI A E,SOKAR S S,ABU-RISHA S E,et al.Combination of tadalafil and diltiazem attenuates renal ischemia reperfusion-induced acute renal failure in rats[J].Biomed Pharmacother,2016,84:861-869.DOI:10.1016/j.biopha.2016.10.009.
• [10] SCARTON M,OPPENHEIMER A,CHA?BI K,et al.Renin-angiotensin-aldosterone system blockers after KDIGO stage 3 acute kidney injury:use and impact on 2-year mortality in the AKIKI trial[J].Crit Care,2019,23(1):148.DOI:10.1186/s13054-019-2447-0.
• [11] PARK C Y,CHOI H Y,YOU N K,et al.Continuous Renal Replacement Therapy for Acute Renal Failure in Patients with Traumatic Brain Injury[J].Korean J Neurotrauma,2016,12(2):89-93.DOI:10.13004/kjnt.2016.12.2.89.
• [12] LUYT C E,BRéCHOT N,DEMONDION P,et al.Brain injury during venovenous extracorporeal membrane oxygenation[J].Intensive Care Med,2016,42(5):897-907.DOI:10.1007/s00134-016-4318-3.
• [13] SOUZA P D,SILIVA L M D,ANDRADE S F D,et al.Recent advances in knowledge of natural-derived bioactive as modulating agents of the renin-angiotensin-aldosterone system:therapeutic benefit in cardiovascular diseases.[J].Curr Pharm Des,2019,25(6):670-684.DOI:10.2174/1381612825666190329122443.
• [14] BOOZARI M,HOSSEINZADEH H.Natural medicines for acute renal failure:A review[J].Phytother Rese,2017,31(12):1824-1835.DOI:10.1002/ptr.5943.
• [15] NEJIM B,ARHUIDESE I,RIZWAN M,et al.Concurrent renal artery stent during endovascular infrarenal aortic aneurysm repair confers higher risk for 30-day acute renal failure[J].J Vasc Surg,2017,65(4):1080-1088.DOI:10.1016/j.jvs.2016.10.112.
• [16] MELCHERT A,BARRETTI P,CH P T,et al.Intradialytic Complications in Dogs with Acute Renal Failure Submitted to Intermittent Hemodialysis[J].Asian J Anim Vet Adv,2017,12(6):288-293.DOI:10.3923/ajava.2017.288.293.
• [17] ATTARIAN S,YU C,ANDERSON K E,et al.Effects of hemin and hemodialysis in a patient with acute intermittent porphyria and renal failure[J].Blood Adv,2017,1(14):915-917.DOI:10.1182/bloodadvances.2017005660.
• [18] TRIVEDI K,HOLLADAY R.Role of Plasma Exhange With Continuous Renal Replacement Therpay (CRRT) for Rhabdomyolysis and Associated Renal Failure Secondary to Synthetic Cannabinoid Abuse[J].Chest,2017,152(4):A392.DOI:10.1016/j.chest.2017.08.418.
• [19] WONG D M,RUBY R E,EATROFF A,et al.Use of Renal Replacement Therapy in a Neonatal Foal with Postresuscitation Acute Renal Failure[J].J Vet Intern Med,2017,31(2):593-597.DOI:10.1111/jvim.14665.
• [20] GAUDRY S,VERNEY C,HAJAGE D,et al.Hypothesis:early renal replacement therapy increases mortality in critically ill patients with acute on chronic renal failure.A post hoc analysis of the AKIKI trial[J].Intensive Care Med,2018,44(8):1360-1361.DOI:10.1007/s00134-018-5210-0.
• [21] 杨美平.重型颅脑损伤并发急性肾损伤患者 NGAL 和 CysC 水平变化及诊断价值[J].中国实用神经疾病杂志,2016,19(19):110-111,112.DOI:10.3969/j.issn.1673-5110.2016.19.069.
• [22] BAITELLO A L,MARCATTO G,YAGI R K.Risk factors for injury acute renal in patients with severe trauma and its effect on mortality[J].J Bras Nefrol,2013,35(2):127-131.DOI:10.5935/0101-2800.20130021.
• [23] SINGH S,PATRA A K,PATEL B,et al.Acute renal failure in the ICU setting:A prospective observational study[J].Med J Armed Forces India,2016,72(3):236-241.DOI:10.1016/j.mjafi.2016.03.009.
• [24] OKUNOLA O O,AROGUNDADE F A,SANUSI A A,et al.Acute renal failure in the intensive care unit:aetiological and predisposing factors and outcome[J].West Afr J Med,2009,28(4):240-244.
• [25] CHEN H,SONG Z,DENNIS J A.Hypertonic saline versus other intracranial pressure-lowering agents for people with acute traumatic brain injury[J].Cochrane Database Syst Rev,2020,1(1):CD010904.DOI:10.1002/14651858.CD010904.pub3.
• [26] BAEK S D,YU H,SHIN S,et al.Early continuous renal replacement therapy in septic acute kidney injury could be defined by its initiation within 24 hours of vasopressor infusion[J].J Crit Care,2017,39:108-114.DOI:10.1016/j.jcrc.2016.12.014.
• [27] GRANADO R C,MACEDO E,CHERTOW E,et al.Toward the Optimal dose Metric in Continuous Renal Replacement Therapy[J].Int J Artif Organs,2012,35(6):413-424.DOI:10.5301/ijao.5000041.
• [28] LEGRAND M,SONNEVILLE R.Understanding the renal response to brain injury[J].Intensive Care Med,2019,45(8):1112-1115.DOI:10.1007/s00134-019-05685-z.
• [29] GAUDRY S,QUENOT J P,HERTIG A,et al.Reply to Chousterman et al.:Delaying Renal Replacement Therapy Could Be Harmful in Patients with Acute Brain Injury[J].Am J Respir Crit Care Med,2019,200(5):646-647.DOI:10.1164/rccm.201904-0723LE.
• [30] CHOUSTERMAN B G,JAMME M,TABIBZADEH N,et al.Delaying Renal Replacement Therapy Could Be Harmful in Patients with Acute Brain Injury[J].Am J Respir Crit Care Med,2019,200(5):645-646.DOI:10.1164/rccm.201903-0527LE.
• [31] UENO T.The Roles of Continuous Renal Replacement Therapy in Septic Acute Kidney Injury[J].Artif Organs,2017,41(7):667-672.DOI:10.1111/aor.
• [32] MAIJA E,VAARA S T,ANNA-MAIJA K,et al.One-and three-year outcomes in patients treated with intermittent hemodialysis for acute kidney injury:prospective observational multicenter post-hoc FINNAKI study[J].Acta Anaesthesiol Scand,2018,62(10):1452-1459.DOI:10.1111/aas.13203.
• [33] WANG A G,DIAMOND M,WADDELL J,et al.Effect of Acetyl-L-carnitine Used for Protection of Neonatal Hypoxic-Ischemic Brain Injury on Acute Kidney Changes in Male and Female Rats[J].Neurochem Res,2019,44(10):2405-2412.DOI:10.1007/s11064-019-02807-3.
• [34] CIVILETTI F,ASSENZIO B,MAZZEO A T,et al.Acute Tubular Injury is Associated With Severe Traumatic Brain Injury:in Vitro Study on Human Tubular Epithelial Cells[J].Sci Rep,2019,9(1):6090.DOI:10.1038/s41598-019-42147-4.
• [35] LUND A,DAMHOLT M B,WIIS J,et al.Intracranial pressure during hemodialysis in patients with acute brain injury[J].Acta Anaesthesiol Scand,2019,63(4):493-499.DOI:10.1111/aas.13298.