脓毒症合并急性肾损伤连续性肾替代治疗的时机选择

Timing of Continuous Renal Replacement Therapy in Sepsis Combined with Acute Kidney Injury

目的:探讨脓毒症合并急性肾衰竭患者进行CRRT的治疗时机。方法:回顾性分析2014年1月-2017年1月入住岑溪市人民医院ICU的脓毒症合并急性肾衰竭行CRRT治疗的89例患者的临床资料。根据2012KDIGO标准将急性肾衰竭患者分为早期组Ⅰ/Ⅱ期39例和晚期组Ⅲ期50例,记录两组患者CRRT治疗前的APECHⅡ、SOFA、肌酐、尿素氮、CRP,并且记录机械通气到启动CRRT时间、使用血管活性药到启动CRRT时间、CRRT使用时间、ICU住院时间及28 d死亡率。经ROC曲线分析两组启动CRRT时机后分出亚组,分别比较早、晚期组中使用血管活性药后较早与较晚启动CRRT组间的CRRT使用时间、ICU住院时间及28 d死亡率。结果:早期组患者的CRRT使用时间、ICU住院时间和28 d死亡率均少于晚期组,差异均有统计学意义(P<0.05)。不同药物组较早启动CRRT亚组的CRRT使用时间和ICU住院时间均短于较晚启动亚组,差异均有统计学意义(P<0.05);不同药物组两个亚组的28 d死亡率比较,差异均无统计学意义(P>0.05)。结论:在脓毒症合并急性肾衰竭的Ⅰ/Ⅱ、Ⅲ期患者分别使用血管活性药后16、8 h内及时启动CRRT为较好时机。

Objective：To investigate the timing of CRRT therapy of the patients with sepsis and acute renal failure.Method：From January 2014 to January 2017,the clinical data of 89 patients who had sepsis and acute renal failure treated in our hospital were retrospective analysed.According to the standard of 2012 KDIGO,the acuterenal failure patients were divided into two groups,39 patients at stageⅠ/Ⅱ were early group,50 patients at stageⅢ were late group.The score of APECHⅡ and SOFA,creatinine,urea nitrogen,CRP data were recorded before therapy,the time of using vasopressor initiation to CRRT initiation（Tv-CRRT）,time of endotracheal intubation to CRRT initiation,time of CRRT,length of ICU stays and 28 days mortality of two group were also recorded.The two groups were divided into subgroups by ROC curve after starting CRRT,the time of CRRT,length of ICU stays and 28 days mortality of two groups and each early and late Tv-CRRT group were compared.Result：The time of CRRT using and ICU stays,28 days mortality of early group were all less than those of late group,the differences were statistically significant（P〈0.05）.The time of CRRT using and ICU stays of earlier subgroups in different group both were shorter than those of the later subgroups,the differences were statistically significant（P〈0.05）;but 28 days mortality of earlier subgroups and later subgroups in different groups were no significant differences（P〈0.05）.Conclusion：CRRT should be start within 16 and 8 h after take vasopressor in the patients with sepsis and acute renal failure at stageⅠ/Ⅱ and Ⅲ.