急性肾损伤患者行连续性床旁血液净化治疗时机的临床研究

Timing of Continous Renal Replacement Therapy and Clinical Outcomes in the Patients with Acute Renal Injury

目的:探讨连续性床旁血液净化(continuous renal replacement therapy,CRRT)治疗时机对急性肾损伤(acute kidney injury,AKI)患者临床预后的影响。方法:选取符合AKI诊断标准并行CRRT治疗的患者83例,以BUN 22 mmol/L为界值,分为早期透析组50例,晚期透析组33例。记录一般临床资料,观察透析开始后28 d、90 d死亡率、肾功能恢复率。结果:(1)早期透析组、晚期透析组28 d、90 d死亡率分别为50.0%vs 72.7%、56.0%vs 78.8%,P<0.05。Kaplan-Meier生存曲线提示早期透析组生存时间显著高于晚期透析组(P<0.05)。晚期透析患者28 d、90 d死亡危险分别是早期透析患者的2.667倍、2.918倍(P<0.05)。(2)早期透析组、晚期透析组28 d、90 d肾功能恢复率分别为44%vs 15.2%、46%vs 15.2%,P<0.01。晚期透析患者28 d、90 d不能脱离透析的危险性是早期透析患者的4.563倍、4.954倍(P<0.01)。结论:早期CRRT治疗可改善AKI患者的肾功能,降低死亡风险。

Objective：To evaluation the relationship between timing of continuous renal replacement therapy （CRRT） in a- cute kidney injury （AKI） and clnical outcomes. Methods ：83 patients treated with CRRT for AKI from 2010 to 2013 were selected. Patients were divided into early or late group, based upon whether the blood urea nitrogen （ BUN ） was less than or greater than 22mmol/L, prior to CRRT initiation. Results：Mortality of the early group was much less than that of the late group at 28 and 90 day （50.0% vs 72.7 % ,56.0% vs 78.8%, P 〈 0.05, respectively）. Kaplan - Meier curve revealed that survival estimate of early group was much higher than that of late group. The relative risk for 28 and 90 day death was associated with initiation of CRRT at higher BUN （ RR 2. 6671 2. 918, P 〈0.05, respectively）. Renal function recovery of the early group was much higher than that of the late group at 28 and 90 day （44.0% vs 15.2% ,46.0% vs 15.2% ,P 〈0.01, respectively）. The relative risk for renal function recovery at 28 and 90 day was associated with initiation of CRRT at higher BUN （ RR 4. 563,4.954, P 〈 O. 01, respectively）. Conclusion： An earlier initiation of CRRT, based on pre - BUN, may improve the rates of survival and renal function recovery in the patients of acute renal injury.