连续性肾脏替代治疗感染性急性肾损伤最佳时机研究

Optimal timing of continuous renal replacement therapy in patients with septic acute kidney injury

目的探讨感染性急性肾损伤(Septic AKI)患者应用连续性肾脏替代治疗(CRRT)的最佳时机。方法以2009年3月至2012年12月大连医科大学附属大连市中心医院外科ICU住院的资料完整的118例感染性AKI患者为研究对象。将其分为2期CRRT组及2期对照组(常规治疗);3期早期CRRT组及3期晚期CRRT组。比较各组患者治疗前及治疗后48 h的血清肌酐、血尿素氮、血清钾、平均动脉压、氧合指数、血乳酸值、尿量、APACHEⅡ评分、SOFA评分;机械通气时间及住ICU时间;28 d及90 d的病死率。结果经过48 h的治疗,3个CRRT组患者的血清肌酐、血尿素氮及血清钾均明显好转,3期早期CRRT组与晚期CRRT组相比下降明显;2期对照组、2期CRRT组及3期早期CRRT组患者的平均动脉压、氧合指数、血清乳酸、尿量、APACHEⅡ评分及SOFA评分均明显好转;3期早期CRRT组与晚期CRRT组相比,平均动脉压、氧合指数、血清乳酸、尿量明显好转;3期早期CRRT组患者的机械通气时间及住ICU时间均明显短于3期晚期CRRT组患者;3期晚期CRRT组的28 d及90 d病死率均明显高于3期早期CRRT组。结论 CRRT是治疗Septic AKI的有效措施;关于Septic AKI患者进行CRRT治疗时机的选择上,对于2期患者,CRRT治疗对患者的预后影响不大;对于3期患者,需尽早予以CRRT治疗。

Objective To investigate the optimal timing of continuous renal replacement therapy（ CRRT） for patients with septic acute kidney injury（ AKI）. Methods We retrospectively analyzed 118 patients admitted to surgical intensive care unit（ SICU）. The hospital information of these patients was complete,and conformed to the 2012 KDIGO stage 2 and above at the same time. All these patients were divided into 4 groups： the stage 2 CRRT group,the stage 2 control group,the stage3 early CRRT group and the stage 3 late CRRT group. The monitoring indicators before and after 48-hour therapy include serum creatinine,serum urea nitrogen,potassium,mean arterial pressure（ MAP）,oxygenation index（ OI）,serum lactic acid level,urine output（ UO）,acute physiology and chronic health evaluation（ APACHE Ⅱ） score,sequential organ failure assessment（ SOFA） score,duration of mechanical ventilation,length of ICU stay,and the 28-day and 90-day mortality. Results After 48-hour treatment,the levels of serum creatinine,blood urea nitrogen and serum potassium in the three groups of patients treated with CRRT were improved obviously. As compared with those in the stage 3 late CRRT group,the above indexes were decreased significantly in the stage 3 early CRRT group. The values of MAP,OI,lactate,UO,APACHE II score and SOFA score in the stage 2 control group,the stage 2 CRRT group and the stage 3 early CRRT group were improved obviously. As compared those in with the stage 3 late CRRT group,the values of MAP,OI,lactate and UO in the stage 3 early CRRT group were improved obviously. As compared with those in the stage 3 late CRRT group,the duration of mechanical ventilation and length of ICU stay in the stage 3 early CRRT group reduced significantly. The 28-day and 90-day mortality were significantly higher in the stage 3 late CRRT group than those in the stage 3 early CRRT group. Conclusion CRRT is an effective method for treatment of patients with septic AKI. For the stage 2 patients,CRRT treatment has little effect on the prognosis of patients. For the stage 3 patients,CRRT treatment should be performed as soon as possible.