脓毒症合并急性肾损伤不同血液净化时机的临床回顾性研究

Clinical retrospective study on different timing of blood purification in sepsis complicated with acute kidney injury

目的探讨脓毒症合并急性肾损伤(AKI)患者不同时机开始连续性肾脏替代治疗(CRRT)的疗效。方法回顾性分析80例脓毒症合并AKI并接受CRRT治疗患者的病历资料。依据KDIGO-AKI诊治指南将患者分为早期组(KDIGO-2期)和晚期组(KDIGO-3期)开始进行CRRT治疗,每组各40例。比较两组患者的急性病生理学和长期健康评价(APACHE)Ⅱ评分、序贯器官衰竭评分(SOFA)、乳酸水平、血肌酐、尿素水平、是否应用机械通气及血管活性药物、28天死亡率、ICU住院时间、总住院时间以及肾功能恢复时间,并比较两组患者相关并发症的发生情况。结果两组患者的SOFA评分、APACHEⅡ评分及呼吸机和血管活性药物的使用、血肌酐、尿素、乳酸水平、28天死亡率、ICU的入住时间及总住院时间比较,差异均无统计学意义(P均>0.05)。两组患者出现导管相关血流感染、出血、栓塞、高钾血症等并发症的差异均无统计学意义(P均>0.05)。两组患者肾功能恢复时间早期组明显早于晚期组(P<0.05)。早期组出现酸中毒的情况低于晚期组,差异有统计学意义(P<0.05)。结论对于脓毒症伴AKI患者,CRRT治疗的最佳治疗时机可能在肾功能进展至AKI-3期之前,尽管早期开展CRRT并没有明显改善患者的死亡率,但是有利于患者肾功能的恢复,减少酸碱失衡的发生。

Objective To investigate the effect of continuous renal replacement therapy(CRRT)on sepsis patients with acute kidney injury(AKI)at different time.Methods The clinical data of sepsis patients with AKI and CRRT(n=80)treated were analyzed 80 cases.According to KDIGO-AKI guidelines,patients were divided into early group(KDIGO-2 phase)and late group(KDIGO-3 phase)to begin CRRT treatment.The acute disease physiology and long-term health assessment(APACHE)II score,sequential organ failure score(SOFA),lactate level,serum creatinine,urea level,mechanical ventilation and vasoactive drugs,28 mortality rate,ICU hospitalization time,total hospitalization time and renal function recovery time were compared between the two groups.The occurrence of related complications.Results There were no significant differences in SOFA score,APACHE II score,use of ventilator and vasoactive drugs,serum creatinine,urea,lactic acid level,28-day mortality,ICU stay time and total hospital stay between the two groups,P>0.05.There was no significant difference in complications such as catheter-related bloodstream infection,hemorrhage,embolism and hyperkalemia between the two groups(P>0.05).The recovery time of renal function in the early group was significantly earlier than that in the late group,and P<0.05.The incidence of acidosis in the early group was lower than that in the late group,with statistical significance(P<0.05).Conclusion For sepsis patients with AKI,the best time for CRRT treatment may be before the progression of renal function to AKI-3.Although early CRRT does not significantly improve the mortality of patients,it is conducive to the recovery of renal function,reducing the occurrence of complications such as acidosis.