集束化治疗对脓毒症相关性急性肾损伤的影响

Influence of care bundle on sepsis related acute kidney injury

目的研究应用尿中性粒细胞明胶酶相关载脂蛋白(neutrophil gelatinase-associated apolipoprotein, NGAL)指导的集束化治疗是否能改善脓毒症相关性急性肾损伤(AKI)的预后。方法入选尿NGAL>130 ng/mL的脓毒症患者,分为标准治疗组与集束化治疗组,比较两组患者的基础临床特征及相关预后。结果①集束化治疗组与标准治疗组比较,第1天液体输入量更高[(4078±849)mL vs.(2664±828)mL,P<0.001)],而第3天液体输入量更少[(2277±733)mL vs.(3086±1056)mL,P<0.001];②集束化治疗组与标准治疗组比较,采用保护性机械通气策略的比例更高(100.0% vs. 87.9%,P<0.001),28 d内机械通气时间更长(22 d vs. 19 d,P<0.001);③集束化治疗组与标准治疗组比较,ICU住院时间更短(9.5 d vs. 10.0 d,P=0.002),肾脏替代治疗比例更低(30.9% vs. 45.5%,P=0.014)。结论集束化治疗可以缩短脓毒症相关性AKI患者的ICU住院时间,提高肾脏功能康复率。

Objective To analyze whether care bundle therapy guided by neutrophil gelatinase - associated apolipoprotein ( NGAL) can improve the prognosis of septic associated acute kidney injury (AKI). Methods Sepsis patients with NGAL > 130 ng/mL were enrolled. They were divided into the standard treatment group and the care bundle treatment group. The basic clinical features and prognosis of the two groups were observed. Results ①Compared to the standard treatment group, the care bundle treatment group infused more fluid on the first day[(4078 ± 849) niL vs.(2664 ± 828) mL, P <0. 001 ]. Nevertheless, the care bundle treatment group infused less fluid on the third day [(2277 ± 733) mL vs.(3086 ± 1056) mL, P <0. 001 ].②The ratio of lung protective ventilation was much higher in care bundle management group ( 100. 0% vs. 87. 9%, P < 0. 001 ). And the non - mechanical ventilation time was much longer (22 d vs. 19 d, P <0. 001 ).③The care bundle treatment group had shorter length stay in ICU (9.5 d vs. 10 d, P =0. 002) and lower kidney replacement rate (30. 9% vs. 45. 5%, P =0. 014). Conclusion Care bundle management can shorten the length of stay in ICU and improve the recovery rate of renal function.