脓毒性休克合并急性肾损伤的CRRT时机研究

Timing of continuous renal replacement therapy in patients with septic shock and acute kidney injury

目的探讨脓毒性休克合并急性肾损伤(acute kidney injury,AKI)患者连续肾脏替代疗法(continuous renal replacemem therapy,CRRT)时机对肾功能和预后的影响。方法回顾性研究2015年1月至2018年9月在上海交通大学医学院附属新华医院急诊监护病房(Emergency Intensive Care Unit,EICu)接受CRRT治疗的脓毒性休克合并AKI患者69例,根据接受CRRT治疗的时间,分为早期组30例(诊断12h内上机)及非早期组39例(诊断12h以后上机),对两组28d全因死亡率、肾功能恢复率、液体平衡、机械通气时间和EICU住院时间进行比较。结果与非早期组比较,早期组28d全因死亡率降低(30%vs.53.8%,P<0.05)、机械通气时间缩短(120.00±16.97h vs.154.80±50.75h,P<0.05),7d液体净入量为负平衡(-92.62±56.21 vs.471.40±124.52,P<0.01)。结论早期CRRT可以降低脓毒性休克合并AKI患者28d全因死亡率,减少机械通气时间,可以更早和更好地进行容量管理。

Objective To investigate the effects of different timing of continuous renal replacement therapy (CRRT)on prognosis and renal function in patients with septic shock and acute renal injury (AKI).Methods A retrospective analysis on 69 patients with septic shock and AKI who received CRRT treatment in the Emergency Intensive Care Unit (EICU)of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2015 to September 2018.According to the initial timing of CRRT treatment,they were divided into early group (within 12 hours of diagnosis,n =30)and non-early group (more than 12 hours after diagnosis ,n=39).28-days mortality,recovery of renal function,fluid balance,mechanical ventilation and IGU stay time were analyzed.Results The 28-days mortality in the early group was significantly lower than non-early group (30% vs.53.8%,P<0.05).The time of mechanical ventilation in the early group was significantly shortened (120.00 ±16.97h vs.154.80 ±50.75h,P <0.05 ),The first 7days of fluid balance in the early group was negative while the other was positive (-92.62±56.21 vs.471.40±124.52,P<0.01).Conclusions Early CRRT can reduce the 28-days mortality rate in patients with septic shock and acute kidney injury,and it can also reduce the time of me- chanical ventilation.We can manage the fluid balance better by early CRRT.