两种血液滤器在肺源性脓毒症合并急性肾损伤患者中的应用价值OA

Objective To compare the application value of AN69-ST hemofilter and AN69-oXiris hemofilter in patients with pulmonary sepsis complicated by acute kidney injury(AKI).Methods A retrospective analysis was performed on the clinical data of 80 patients with pulmonary sepsis complicated by AKI admitted to Mianyang Central Hospital from January 2023 to December 2024.All patients received standard treatment for pulmonary infection and sepsis,and on this basis,continuous renal replacement therapy(CRRT)was given.According to the different hemofilters used,patients treated with AN69-ST hemofilter were included in the AN69-ST group,and those treated with AN69-oXiris hemofilter were included in the AN69-oXiris group.With gender,age,type of severe pneumonia,and sequential organ failure assessment(SOFA)score as matching variables,propensity score matching was performed at a ratio of 1∶1 to obtain 40 patients in the AN69-ST group and 40 patients in the AN69-oXiris group with balanced baseline data.The clinical outcomes(in-hospital and 90-day treatment mortality),as well as the SOFA score,lactate,liver and kidney function indexes[alanine transaminase(ALT),aspartate transaminase(AST),blood urea nitrogen(BUN),serum creatinine(SCr)],inflammatory markers[interleukin-6(IL-6),procalcitonin(PCT)],coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)]before and after treatment were compared between the two groups.The rehabilitation process[length of intensive care unit(ICU)stay,duration of CRRT,time to urine volume recovery,total length of hospitalization],hospitalization costs,long-term dialysis rate and complication rate were compared between the two groups.Results The in-hospital mortality rate in AN69-oXiris group[5.00％(2/40)]was lower than that in AN69-ST group[20.00％(8/40)](P＜0.05),while no significant difference was observed in the 90-day treatment mortality rate between the AN69-oXiris group[12.50％(5/40)]and the AN69-ST group[30.00％(12/40)](P＞0.05).At 24 h and 72 h after treatment,the serum levels of lactate,creatinine,IL-6,PCT,PT,APTT,and FIB in the AN69-oXiris group were significantly lower than those in the AN69-ST group(P＜0.05),but there were no significant between-group differences in SOFA score,ALT,AST and BUN at 24 h and 72 h post-treatment(P＞0.05).The length of ICU stay,time to urine volume recovery,duration of CRRT and total length of hospitalization were shorter,but the long-term dialysis rate was lower in the AN69-oXiris group compared with the AN69-ST group(P＜0.05).The incidence of filter coagulation in the AN69-oXiris group[10.00％(4/40)]was lower than that in the AN69-ST group[32.50％(13/40)](P＜0.05).No significant differences were found between the two groups in the incidences of puncture site hematoma,catheter-related bloodstream infection,catheter obstruction/displacement,bleeding events and thrombocytopenia,as well as hospitalization costs(P＞0.05).Conclusion The application of AN69-oXiris hemofilter during CRRT can alleviate inflammatory response and renal injury,improve coagulation function,reduce disease severity,accelerate recovery,and lower in-hospital mortality in patients with pulmonary sepsis complicated by AKI.Meanwhile,it carries a lower risk of filter clotting without additional hospitalization costs.Although no definite superiority was observed in reducing 90-day treatment mortality,it yields significant comprehensive benefits in short-term clinical outcomes and rehabilitation progress.