CRRT治疗感染性急性肾损伤最佳时机探讨

Best opportunity for CRRT to treat infectious acute kidney injury

目的探讨连续性肾脏替代治疗(CRRT)治疗感染性急性肾损伤的最佳时机,以期为急性肾损伤患者的规范治疗提供一定的临床数据。方法选取2013年1月—2015年12月杭州师范大学附属医院ICU住院且资料齐全的接受CRRT治疗的感染性急性肾损伤患者120例,按照急性肾功能衰竭的改善全球肾脏病预后组织(KDIGO)诊断标准分为Ⅰ、Ⅱ、Ⅲ期组。比较各组的住院病死率和肾功能恢复率,并比较各组患者治疗前及CRRT治疗后48 h的APACHEⅡ评分、SOFA评分、氧合指数(OI)、平均动脉压(MAP)、血清肌酐(Scr)、血尿素氮(BUN)、需要血管活性药物例数。结果 3组患者病死率和肾功能完全恢复率相比差异具有统计学意义(χ~2=10.394、22.200,均P<0.05)。Ⅲ期病死率显著高于Ⅰ期和Ⅱ期,肾功能完全恢复率显著性低于Ⅰ期和Ⅱ期,差异均具有统计学意义(χ~2≥6.545,均P<0.017)。Ⅰ期和Ⅱ期组患者治疗后血清肌酐、血尿素氮、氧合指数、平均动脉压、APACHEⅡ评分、SOFA评分均较治疗前显著改善(t≥4.09,均P<0.05);Ⅲ期组患者治疗前后APACHEⅡ评分、SOFA评分、OI、MAP、Scr、BUN、需要血管活性药物例数指标无显著性变化(t≤1.61,均P>0.05)。结论 CRRT治疗可明显改善KDIGO标准分期Ⅰ、Ⅱ期患者的预后,而对Ⅲ期患者预后影响不大,故临床上必须重视CRRT时机的选择。

Objective To discuss the best opportunity of using continuous renal replacement therapy（ CRRT） for the treatment of infective acute kidney injury,and provide certain clinical data for standard treatment in patients with acute kidney injury. Methods From January,2013 to December,2015,120 patients with acute kidney injury having CRRT treatment in our hospital were chosen and divided intoⅠ,Ⅱ and Ⅲ period group by KDIGO criteria. The hospital mortality and renal function recovery rate were compared among the three groups. The APACHE Ⅱ score,SOFA score,oxygenation index,mean arterial pressure,levels of serum creatinine and blood urea nitrogen,cases using vascular active drug were compared before and 48 h after CRRT treatment in each group. Results The mortality and renal function complete recovery rate among the three groups had statistically significant differences（ χ2= 10. 394 and 22. 200,all P〈 0. 05）. The mortality rate in phase Ⅲ group was significantly higher than that in phase Ⅰ and phase Ⅱ group,while the renal function fully recover rate in phase Ⅲ group was significantly lower than that in phase I and phase Ⅱ group,the differences was statistically significant（ χ2≥6. 545,all P 〈0. 017）. The serum creatinine,blood urea nitrogen,oxygenation index,mean arterial pressure,APACHE Ⅱ score and SOFA score in phase Ⅰ and phase Ⅱ groups were improved significantly after the treatment（ t≥4. 09,all P〈 0. 05）,but not in phase Ⅲ group（ t≤1. 61,all P〉 0. 05）. Conclusion CRRT treatment can obviously improve the prognosis of period Ⅰ and Ⅱ patients,but not of period Ⅲ patients（ KDIGO standard）,the best opportunity for CRRT should be paid more attention in practice.