小剂量利尿剂对CRRT治疗急性肾损伤患者血清中胱素C的影响

Effects of low does diuretics on serum angiotensin C in patients with acute kidney injury receiving by continuous renal replacement therapy

目的:分析小剂量利尿剂对接受连续肾脏替代治疗(CRRT)的急性肾损伤(AKI)患者血清中胱素C(Cysc)的影响。方法:选取接受CRRT的AKI患者80例,依据CRRT前1 d的尿量变化分为利尿剂组[呋塞米,30~35 m L/(kg·h),尿量<400 m L/h]40例,非利尿剂组(尿量>400 m L/h)40例,观察CRRT前1 d、CRRT后起初3d肾功能、CRRT时间和住ICU时间等指标。结果:(1)需血管活性药、有创机械通气、平均动脉压(MAP)、血乳酸、血K+、CRRT时间、住ICU时间和住院时间在2组之间有显著统计学差异(均P<0.01);(2)CRRT治疗前1 d、CRRT治疗后1、2和3 d,利尿剂组中Cys-C、尿素氮(BUN)、血肌酐(SCr)和尿量降低比非利尿剂组更快(均P<0.05)。(3)利尿剂组28 d存活率高于非利尿剂组[32(80.0%)vs 26(65.0%),P<0.05]。结论:CRRT治疗AKI患者过程中,小剂量利尿剂能改善肾功能,缩短CRRT时间、住ICU时间及住院时间,改善AKI患者预后。

Objective：To analyze the effect of low dose diuretics on serum angiotensin C in patients with acute kidney injury（AKI） receiving continuous renal replacement therapy（CRRT）.Methods：Eighty patients with AKI receiving CRRT from March 2014 to March 2016 in our hospital were selected,and on the basis of the change of urine one day before CRRT,divided into diuretics groups（urine 400 m L/h）（n = 40）,the non-diuretic group（urine 400 m L/h）（n = 40）.On the day before and 3 days after CRRT,the renal function,CRRT duration,and lengths of ICU and hospital stay were observed,and SPSS20.0 software was used for statistical analysis.Results：（1） The use of vasoactive drugs,invasive mechanical ventilation,MAP,lactic acid,potassium,CRRT duration,ICU stay and hospital stay showed statistically significant differences between two groups（P〈0.01）.（2） One day before and 3 days after CRRT,the reduction in Cys-C,BUN,SCr and urine volume in the diuretics group was significantly faster than that in the non-diuretics group（P〈0.05）.（3） The 28-day survival rate in the diuretic group was significantly higher than in the non-diuretic group [32（80.0%） vs 26（65.0%） ]（P〈0.05）.Conclusion：In the process of CRRT in patients with AKI,the low-dose diuretics can improve renal function,shorten the CRRT duration,and ICU and hospital stay,and improve the prognosis of patients with AKI.