连续肾脏替代疗法对感染性休克致急性肾损伤患者的临床意义

Clinical Significance of Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Induced by Septic Shock

目的探讨连续肾脏替代疗法(CRRT)治疗对感染性休克(SS)致急性肾损伤(AKI)患者治疗效果及生存率的影响。方法将我院收治的252例SS致AKI患者随机分为接受CRRT治疗的CRRT组和接受间歇性血液透析(IHD)治疗的IHD组,各126例,比较两组治疗前后血二氧化碳结合力(CO_2-CP)、肾功能指标、血乳酸、急性生理和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及生存率等情况。结果治疗24、48h后,两组血CO_2-CP水平均明显升高(P<0.05),血乳酸、肌酐和尿素氮水平均明显降低(P<0.05);APACHEⅡ、SOFA评分均明显降低(P<0.05);CRRT组与IHD组血CO_2-CP、乳酸、肌酐、尿素氮水平比较,差异有统计学意义(P<0.05);CRRT组与IHD组APACHEⅡ、序贯器官衰竭(SOFA)评分比较,差异有统计学意义(P<0.05);CRRT组与IHD组多器官功能障碍综合征(MODS)发生率和死亡率比较,差异有统计学意义(P<0.05)。结论 CRRT治疗SS致AKI疗效确切,可改善患者酸碱平衡和肾功能,提高生存率。

Objective To explore the effects of continuous renal replacement therapy（CRRT） on the treatment efficacy and survival rate of patients with acute kidney injury（AKI） induced by septic shock（SS）. Methods252 cases of patients with SS-induced ARF admitted in our hospital were randomly divided into the CRRT group（n = 126,given CRRT） and the IHD group [n = 126,given intermittent hemodialysis（IHD）]. The blood carbon dioxide combining power（CO2-CP）,renal function indexes,blood lactate,acute physiology,score of the chronic health status score system II（APACHE II） and the survival rate were compared between the two groups before and after treatment. Results After 24 and 48 h of treatment,the blood CO2-CP levels in the two groups were increased significantly（P〈0. 05） while levels of blood lactate,creatinine and urea nitrogen were significantly decreased（P〈0. 05）,and the scores of APACHEII and SOFA were significantly decreased（P〈0. 05）. There were significant differences in the levels of blood CO2-CP,lactate,creatinine and urea nitrogen between the CRRT group and the IHD group（P〈0. 05）. There were significant differences in the scores of APACHE II and sequential organ failure assessment（SOFA） between the two groups（P〈0. 05）. There were also significant differences in the incidence rate of multiple organ dysfunction syndrome（MODS） and the mortality rate between the CRRT group and the IHD group（P〈0. 05）. Conclusion Applying the CRRT for SS-induced AKI can have the promising efficacy. It can improve acid-base balance and renal function for patients,and enhance the survival rate.