| Objective: To evaluate the efficacy of continuous renal replacement therapy in patients with primary septic shock and acute kidney injury.But all sorts of anticoagulant solution in septic shock with CVVH therapy in patients with acute kidney injury is still could not qualitative,domestic and foreign research reports also have different results,this part of the patients with anticoagulant strategy choice is still CVVH technical problems,especially the way that different anticoagulation on the filter efficiency is relatively few clinical studies.This study from the prognosis of patients with anticoagulant effect,and filter use efficiency,etc.,compared to ordinary heparin anticoagulation,citrate in vitro local anticoagulation with heparin saline flushing commonly used three kinds of anticoagulant solution used in patients with septic shock associated with acute kidney injury,thus to put forward the strategy for such patients choose reasonable method of anticoagulant,thus to achieve safe and effective treatment.Methods: A total of 270 cases of patients with acute kidney injury in the 1st Hospital affiliated of Hebei north college,the 2nd affiliated Hospital of Hebei north college and 3th Hospital of zhangjiakou,who were clearly diagnosed with septic shock with as the research object from January 2015 to January 2018.According to the numerical table method,the group A was randomly divided into three groups: group A took small dose heparin anticoagulation,group B was used in vitro anticoagulation of citric acid,and group C took the non-heparin physiological saline to wash anticoagulation.The blood routine,renal function(BUN,SCr),liver function(ALT,total bilirubin TBiL)and other indicators were monitored before the CRRT treatment in 3 groups.Dynamic monitoring of blood pressure,heart rate,respiration,body temperature,percutaneous oxygen saturation and conscio-usness and other vital signs in the three groups;Blood lactate concentrations were detected 6 hours and 24 hours after admission in 3 groups,and 6 hours of blood lactate clearance was calculated.Three groups of patients were tested for thrombin time(PT),partial thrombin time(APTT)and platelet count(PLT)before and after CRRT.To monitor the use of efficacy indicators in the treatment of blood purification in 3 groups of patients,such as cross-mold pressure,arterial pressure,venous pressure and ultrafiltration rate.Record the actual use time of 3 sets of filters,and determine the efficiency of the filter.The complications of hemorrhage,metabolism and hypocalcemia were observed in 3 groups.Results:1.In terms of blood routine indexes,there was no significant difference in WBC level and HGB level before and after CRRT in the three groups(P>0.05).2.In terms of liver function index,there was no significant difference in ALT level and TBiL level before and after CRRT in the three groups(P>0.05).3.In terms of renal function,the level of BUN and SCr were significantly lower after the treatment of CRRT in the three groups,and the difference was statistically significant(P<0.05).Comparison between groups,group B level of BUN,SCr levels after treatment in patients with improved significantly better than that of group A and group C(P<0.05),while A group of patients after treatment improved level of BUN,SCr level is obviously better than that of group C(P<0.05).4.In terms of lactate clearance rate,B group of patients admitted to hospital after 6h,24 h blood lactate clearance rate is significantly higher than in group A and group C,the difference was statistically significant(P<0.05),while A group of patients admitted to hospital after 6 h,24 h blood lactate clearance is significantly higher than C group,the difference was statistically significant(P<0.05).5.In the aspect of function of blood coagulation and platelet count,patients in group A and group C after treatment was significantly prolong the APTT values,while PLT value was significantly reduced,the differences were statistically significant(P<0.05);The APTT values and PLT value changes before and after treatment in group B were not statistically significant(P>0.05).There was no significant difference in PT values before and after treatment in the three groups(P>0.05).6.In terms of the efficiency of the filter,the patients in group A and group B were relatively stable during the treatment of transmembrane pressure,venous pressure,arterial pressure and ultrafiltration rate,and the arterial pressure variation in group C was significantly different.7 the use of time and the use efficiency filter filter,filter used for A group B patients in group A,group C extended obviously,differences were statistically significant(P<0.05),A set of filter used for A group C extended obviously,differences were statistically significant(P<0.05);In group B,the obvious efficiency of the filter was significantly higher than that of group A and group C,while group A was significantly higher than group C,and the difference was statistically significant(P<0.05).8.In the treatment of complications and mortality,there was no significant difference between the three anticoagulation techniques in the treatment of hemorrhage,hypocalcemia and metabolic complications(P>0.05).The mortality of group B was significantly lower than that in group A and group C,and the difference was statistically significant(P<0.05).Conclusions:1.Heparin anticoagulation,citric acid in vitro anticoagulation and non-heparin physiological saline rinsing these three anticoagulant methods have no obvious effect on the blood routine and liver function of patients with septic shock and acute renal injury;2.Extracorporeal citrate anticoagulation in improve kidney function in patients with septic shock complicating acute kidney injury,increase the efficiency of the filter used,prolong the service life of the filter,is better than heparin anticoagulation,without heparin saline irrigation;3.Extracorporeal citrate anticoagulation in improving the prognosis of patients with septic shock complicating acute kidney injury,reduce clinical mortality,is better than heparin anticoagulation,saline irrigation,and does not increase bleeding,hypocalcemia,the body's metabolism related complication rate,relative safety and reliability. |
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