脓毒症合并急性肾损伤3期患者启动肾脏替代治疗时机的研究

Study on the beginning of renal replacement therapy for acute kidney injury stage 3 in sepsis patients

目的探讨早期启动肾脏替代治疗(renal replacement therapy,RRT)能否降低脓毒症合并急性肾损伤(acute kidney injury,AKI)3期患者的90天全因病死率。方法 69例脓毒症合并AKI 3期患者随机分为早做组(n=35,入组后立即行RRT)、晚做组(n=34,出现紧急指征时开始RRT),RRT采用连续性血液透析滤过联合血液灌流模式。主要终点事件是90天内全因病死率。次要指标有机械通气时间,ICU住院天数、总住院天数。结果 90天全因病死率比较,早做组(42.9%)略低于晚做组(50%),差异无统计学意义(χ~2=0.354,P=0.552)。早做组机械通气时间为(286±147)h,晚做组为(334±172)h,差异无统计学意义(t=-1.125,P=0.265)。早做组ICU住院天数为[12(10,16)]天,晚做组为[16(12,22)]天,差异无统计学意义(Z=-1.555,P=0.120);早做组总住院天数为[20(18,24)]天,晚做组为[26(19,30)]天,有显著差异(Z=-2.440,P=0.015)。结论 (1)脓毒症并发AKI 3期患者早期RRT与推迟RRT的病死率无显著差异。(2)早期RRT可降低平均住院天数。

Objective To determine whether early initiation of renal replacement therapy （RRT） can re- duce all-cause mortality within 90 days in sepsis patients complicated with acute kidney injury （AKI）. Meth- ods Sixty-nine sepsis patients with AKI stage 3 were enrolled in this study and randomly assigned into early group （n=35） in which RRT was initiated immediately after randomization, or delayed group in which RRT was initiated when emergent indications appeared. Continuous hemofiltration combined with hemoperfusion was the RRT mode. The primary end point was all-cause mortality within 90 days after randomization. The secondary end points included mechanical ventilation period, staying in ICU period and hospitalization day. Results All-cause mortality within 90 days did not differ significantly between early group （42.9%） and de- layed group （50%） （x2=0.354, P=0.552）. Mechanical ventilation time was similar between early group and de- layed group （286±147h vs. 334±172 h; t=-1.125,P=0.265）. The period staying in ICU was similar between the two groups [12 （10, 16） days in early group vs. 16 （12, 22） days in delayed group; Z=-1.555, P=0.120], hut hospitalization day was significantly shorter in early group than in delayed group [20 （18, 24） days vs. 26 （19, 30） days; Z=-2.440, P=0.015]. Conclusions For sepsis patients complicated with AKI stage 3, there was no significant difference in mortality between early and delayed initiation of RRT. However, early RRT can reduce the average hospitalization day.