不同连续性血液净化介入时机对老年多脏器衰竭合并急性肾损伤预后的影响

Influence of timing of initiation of continus renal replacement therapy on prognosis of geriatric patients with multiple organ failure and acute kidney injury

目的探讨不同连续性血液净化(CRRT)介入时机对老年多脏器衰竭(MODS)合并急性肾损伤(AKI)患者预后的影响。方法选择解放军第四六四医院2014年12月~2016年8月老年MODS并接受CRRT治疗的患者96例,根据CRRT治疗前AKI分期将患者分为3组,每组各32例,A组患者在AKI 1期开始CRRT治疗,B组患者在AKI2期开始治疗,C组患者在AKI 3期开始治疗。观察比较三组患者首次CRRT治疗前的血常规、肾功能、电解质、C反应蛋白(CRP)、白介素(IL)-18/IL-6、尿液中性粒细胞凝胶酶相关脂质运载蛋白(NGAL)、B型尿钠肽(BNP)、肿瘤坏死因子α(TNF-α)、APACHEⅡ评分,14、28 d肾功能恢复率以及14、28 d生存率。结果 A组、B组14、28 d生存率均高于C组(P<0.05),A组肾功能恢复率高于B组、C组(P<0.05),三组间治疗前CRP、IL-18/IL-6、NGAL、BNP、TNF-α、APACHEⅡ评分差异有统计学意义(P<0.05)。回归分析发现:NGAL、BNP、APACHEⅡ评分是患者预后的独立影响因子(P<0.05)。结论老年MODS患者如合并AKI,应尽早开始CRRT治疗,可有效改善患者预后。介入时机除了AKI分期以外,还可参考NGAL、BNP、APACHEⅡ等综合分析。

Objective To investigate the influence of timing of initiation of continues renal replacement therapy （CRRT） on the prognosis of geriatric patients with multiple organ failure （MODS） and acute kidney injury （AKI）. Methods From December 2014 to August 2016, in 464 Hospital of PLA, 96 geriatric MODS patients with CRRT were selected. The patients were divided into 3 groups according to AKI stages, with 32 patients in each group： group A （CRRT started at AKI stage 1）, group B （CRRT started at AKI stage 2） and group C （CRRT started at AKI stage 3）. The blood routine, renal function, electrolyte, CRP, IL-18/IL-6, NGAL, BNP, TNF-α, APACHE Ⅱ score before first CRRT, survival rate and recovery rate of renal function in 14, 28 d in different group were compared. Results The survival rate of group A and group B were higher than that of group C （P 〈 0.05）. Renal function recovery rate in group A than was higher group B and group C （P 〈 0.05）. CRP, IL-18/IL-6, NGAL, BNP, TNF-α and APACHE Ⅱ score before CRRT of three groups were compared, the difference was statistically significant （P 〈 0.05）. Regression analysis showed that： NGAL, BNP, APACHEⅡ score were independent factors for patients＂ prognostic （P 〈 0.05）. Conclusion Geriatric patients with MODS and AKI should start CRRT as soon as possible, which can effectively improve the prognosis of patients. In ad- dition to the AKI classification, NGAL, BNP, APACHE integration should be considered as timing references.