- 期刊
Short-term consequences of continuous renal replacement therapy on body composition and metabolic status in sepsis
连续性肾替代治疗在短期内对脓毒症患者机体组成和代谢状态的影响
摘要
背景和目的：重症监护接收治疗的脓毒症患者由于炎症介质的大量生成，往往会出现液体超负荷和代谢亢进的表现。连续性肾替代治疗是一种可以持续缓慢清除机体内过多的液体和细胞因子的有效的体外生命支持技术。本研究目的在于研究连续性肾替代治疗在短期内对机体组成成分和能量代谢的影响。方法和研究设计：本研究共纳入27名重症监护接受连续性肾替代治疗的脓毒症患者，在入院时、肾替代治疗前后分别进行机体成分分析和间接能量消耗检测，并记录其他可能对检测结果造成影响的临床因素，对各种因素与结果进行了相关性分析。结果：与肾替代治疗前相比，治疗后的患者液体超负荷和代谢亢进明显改善，患者静息能量消耗下降程度与细胞内水的变化及肾替代治疗持续时间呈正相关（r=0.547，p=0.003；r=0.515，p=0.006），而与置换液温度呈负相关（r=−0.668，p=0.001）。结论：连续性肾替代治疗可以在短期内显著改善脓毒症患者的液体负荷与代谢亢进状态，但对其营养状态并无显著影响；连续性肾替代治疗联合其他辅助支持治疗或许会发挥其最大临床优势。
並列摘要
Background and Objectives: Fluid overload and hypermetabolism frequently occur in sepsis patients in the intensive care unit (ICU) setting. These abnormalities correlate with inflammatory mediators released under stressful conditions. Continuous renal replacement therapy (CRRT) is an extracorporeal life support technology that persistently and stably eliminates overhydration and cytokines. This study investigated the short-term consequence of CRRT on body composition and pattern of energy expenditure. Methods and Study Design: We prospectively observed 27 sepsis patients in our ICU treated with CRRT. Bioelectrical impedance analysis and indirect calorimetry were determined at admission and before and after CRRT. All parameters considered to affect body composition and metabolic state with short-term CRRT were recorded. We used correlation analysis to evaluate the relationship between the change of nutritional state and other parameters. Results: Patients had a decreased total body water load and an improved metabolic pattern, but the nutritional parameters had no significant change between pre- and post-CRRT. Furthermore, we observed the percentage variation of resting energy expenditure (REE) was positively correlated with intracellular water change (r=0.547, p=0.003) and CRRT duration (r=0.515, p=0.006). A negative correlation was found between the percentage variation of REE and dialysate temperature (r=- 0.668, p=0.001). Conclusion: These results suggest that short-term CRRT reduces systemic volume in sepsis patients with overhydration and hypermetabolism, but has no significant impact on acute nutritional status. Meanwhile, CRRT may exert its optimum efficiency when accompanied by other medical practices and support methods.