CRRT在脓毒血症急性肾损伤患者救治中的临床研究

Clinical Study of CRRT in the Treatment of Patients with Sepsis Acute Kidney Injury

目的集中探讨采用针对脓毒血症急性肾损伤(AKI)患者采用连续性肾脏代替治疗(continunous renal replacement therapy,CRRT)进行救治过程中的临床研究。方法选取脓毒血症急性肾损伤患者200例,随机分为采用CRRT治疗的观察组和采用常规药物治疗的对照组,对采用不同方法进行治疗的两组患者救治过程中的临床指标变化进行对比分析。结果在为期30天的临床疗效的比较中,观察组较对照组在生存率和死亡率的比较中,均具有明显生存优势,差异较大,具有统计学意义(P<0.05)。对照组在AKI分期的比较中,针对NⅠ、NⅡ,存活患者较死亡患者差异不大,不具有统计学意义(P>0.05);在NⅢ的比较中,存活患者明显低于死亡患者,具有明显的统计学意义(P<0.01);而观察组患者在AKI分期的比较中,在N1和NⅢ的比较中,存活患者较死亡患者差异较大,具有明显的统计学意义(P<0.01);在合并症的发病率中的比较中,两组患者中存活患者的发病率明显低于死亡患者,差异较大,具有明显的统计学意义(P<0.01);观察组患者中,存活患者较死亡患者在慢性阻塞性肺炎治疗的时间间隔的比较中差异不大,不具有统计学意义(P>0.05);但是存活患者在从入ICU到入行CRRT的时间间隔明显短于死亡患者,差异较大,具有明显的统计学意义(P<0.01)。结论CRRT在对于脓毒血症急性肾损伤患者治疗的过程中可有效的清除炎症因子,从发病机制上降低疾病的死亡率,维持内环境的相对稳定性,尽早使用CRRT治疗可有效地提高患者的30天存活率。

Objective To investigate the clinical application value of continuous renal replacement therapy（ CRRT） in the treatment of patients with sepsis acute kidney injury（ AKI）. Methods 200 patients with septic acute kidney injury were randomly divided into observation group（ 100 patients treated with CRRT） and control group（ 100 patients treated with conventional drugs）. The changes of clinical indexes in both groups were analyzed. Results The survival and mortality rate in observation group during 30 days treatment had obvious advantage compared with control group（P〈0. 05）. As to the AKI staging in control group,there was no significantly difference in the NI and NII between survival and death patients（P〈0. 05）,while in NIII,the survival patients were significantly lower than that of the death patients（P〈0. 01）. The significant difference on AKI NI and AKI NIII in observation group were seen between survival and death patients（P〈0. 01）. The incidence of complications rate in survival patients was much less than that of death patients in both two groups（P〈0. 01）. There was no significantly difference in the treatment time interval of chronic obstructive pneumonia between survival and death patients in observation group（P〈0. 05）. However,the time interval from entering ICU to carrying CRRT in survival patients was significantly shorter than that of death patients（P〈0. 01）. Conclusion CRRT could effectively remove inflammatory factor in the treatment of patients with sepsis acute kidney injury,reduce the mortality and maintain the relative stability of internal environment. The early CRRT application might improve the 30-days survival rate of patients with sepsis acute kidney injury.