持续肾脏替代治疗时机对感染性休克合并急性肾损伤患者预后的影响

Influence of initiation timing of continuous renal replacement therapy on prognosis of patients with septic shock and acute kidney injury

目的探讨持续性肾脏替代治疗(CRRT)时机对感染性休克合并急性肾损伤(AKI)患者预后的影响及死亡危险因素。方法选择本院重症监护病房(ICU)感染性休克合并达到RIFLE诊断标准功能衰竭阶段的急性肾损伤(AKI)患者63例,根据治疗开始时机将患者随机分为2组,早期组(n=33)诊断后12 h内开始CRRT,晚期组诊断后48 h后开始CRRT(n=30),比较2组患者生存率,并采用多元回归分析死亡危险因素。结果治疗前,2组患者年龄、手术情况、病史和疾病危重程度等方面差异均无统计学意义(P>0.05)。经Log-Rank检验,2组各时段生存率差异无统计学意义(P=0.574)。Cox回归分析提示,血乳酸和APACHEⅡ评分是影响患者预后的独立危险因素。结论 CRRT治疗开始时机选择对于感染性休克合并急性肾损伤患者短期预后影响不大。

Objective To investigate the influence of initiation timing of continuous renal replacement therapy(CRRT)on prognosis of patients with septic shock and acute kidney injury,and its risk factors for death.Methods A total of 63 cases with septic shock and acute kidney injury(AKI)that reaching diagnostic criteria for failure in ICU of our hospital were randomly divided into two groups according to initiation timing,the early group(n=33)started CRRT with in 12 h and late group(n=30)started 48 h.The survival rate of two groups were compared,Cox regression analysis was performed to evaluate the risk factors of death.Results There were no significant difference in age,surgery condition,medical history and severity of disease between two groups before treatment.Log-Rank test shoed no significant difference in survival rate(P=0.574).Cox regression analysis showed that blood lactate and APACHEⅡscores were the independent risk factors of prognosis.Conclusion Timing of CRRT has no effect on patients with septic shock and acute kidney injury.