CRRT介入时机与重症急性肾损伤患者预后关系的初步探讨

Timing of Continuous Renal Replacement Therapy in the Critically Ill Patients with Acute Kidney Injury

目的：探讨连续性肾脏替代治疗（CRRT）的介入时机与重症AKI患者预后的关系。方法：回顾性分析四川大学华西医院2011年1月-2014年12月重症监护病房（ICU）收治的共182例行CRRT治疗的AKI患者,采用改善全球肾病预后组织（KDIGO）制定的急性肾损伤（AKI）分期标准,根据AKI的不同分期分为1、2、3期共三个亚组,观察各组患者住院死亡率、存活患者肾功能转归、CRRT治疗时间和ICU平均住院时间。收集分析患者的临床指标和生化指标。结果：AKI 1期组患者死亡率34.1%,AKI 2期组患者死亡率40%,均显著性低于AKI 3期组患者的死亡率64.6%（P〈0.05）。AKI 1、2期组存活患者肾功能改善率较3期组显著提高（P〈0.05）。三组患者ICU平均住院时间、CRRT治疗时间差异无统计学意义（P〉0.05）。死亡患者和存活患者的ICU住院天数、血管升压药使用、尿量、血钾、AKI分期、pH值、SOFA评分差异有统计学意义（P〈0.05）。通过Logistic回归模型,发现AKI分期、SOFA评分、使用血管升压药是影响预后的独立危险因素。结论：根据KDIGO-AKI分期标准,在ICU住院的AKI 1、2期患者较3期患者,早期进行CRRT治疗能明显降低患者住院死亡率,改善肾功能。治疗前的SOFA评分、AKI分期、血管升压药是影响其预后的独立危险因素。

Objective： To investigate the association between the initial timing of continuous renal replacement therapy（ CRRT） and the outcomes in AKI patients with critical illness,which staged by the criteria of Kidney Disease Improving Global Outcomes Organization（ KIDGO）. Methods： We retrospectively analyzed 182 AKI patients receiveing CRRT from January 2011 to December 2014 in West China Hospital of Sichuan University. These patients were divided into three arms by KIDGO- AKI staging. The outcomes included in- hospital mortality,the recovery rate of kidney function in survivals,duration of CRRT and ICU- stay days.All possible clinical data and blood biochemical parameters were collected. Results： The mortality of AKI stage 1 and stage 2 was 34. 1% and 40% respectively,which were significantly lower than that of stage 3（ 64. 6%）（ P〈0. 05）. Furthermore,the recovery rate of renal function of AKI stage 1 and 2 were significantly higher than that of AKI stage 3（ P〈0. 05）. There were significant differences between survivors and non- survivors in r ICU- stay days,dose of vasopressors,urine volume,serum potassium,stage of AKI,PH value and baseline SOFA score（ P〈0. 05）. Conclusion： KDIGO- AKI criteria is an useful tool to evaluate the initial timing of CRRT for critical AKI patients in ICU. Patients receiving CRRT in stage 1 and 2 are associated with significantly lower mortality rate and better recovery of kidney function than those in stage 3. The SOFA score,stage of AKI and the usage of vasopressor drugs are independent risk factors of outcomes in such patients.