CRRT含糖置换液对心脏术后合并急性肾损伤患者血糖以及预后的影响

Influence of continuous renal replacement therapy(CRRT)sugar-containing replacement fluid on blood glucose and prognosis in patients with acute kidney injury(AKI)after cardiac surgery

目的探讨连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)含糖(浓度10 mmol/L)置换液对心脏术后急性肾脏损伤(Acute kidney injury,AKI)患者血糖及其预后的影响。方法收集2012年4月至2018年7月行CRRT治疗心脏术后AKI患者140例,根据置换液是否含糖分为两组,其中含糖组80例,CRRT治疗中使用含糖置换液(含糖浓度为10 mmol/L);不含糖组60例使用不含糖置换液,主要观察指标为CRRT治疗后24 h、72 h血糖值,次要观察指标为CRRT治疗后14 d、28 d及90 d的预后,分析使用2种不同置换液对患者血糖的影响。结果两组患者在CRRT中24 h血糖值比较,差异无统计学意义(P>0.05);含糖组CRRT中72 h血糖为(9.39±3.13)mmol/L,高于不含糖组(7.57±2.86)mmol/L,差异有统计学意义(P<0.05);两组患者在接受CRRT后72 h APACHE评分、14 d、28 d、90 d预后比较,差异均无统计学意义(均P>0.05)。结论CRRT置换液含糖组和不含糖组对心脏术后急性肾脏损伤患者72 h血糖有影响,在接受含糖置换液CRRT治疗中,72 h内需要加强血糖的监测与调控。含糖置换液相对不含糖置换液,并不会影响患者血糖及其预后。

Objective To investigate the influence of continuous renal replacement therapy (CRRT) sugar-containing replacement fluid (10 mmol/L) on blood glucose and prognosis in patients with acute kidney injury (AKI) after cardiac surgery.Methods 140 patients with AKI after cardiac surgery who underwent CRRT from April 2011 to July 2018 were selected,and were divided into two groups.80 cases in the sugar-containing group were given sugar-containing replacement fluid (10 mmol/L) during the CRRT,and 60 cases in the sugar-free group were given sugar-free replacement fluid.Blood glucose levels of the patients were observed 24 h and 72 h after CRRT.The prognosis of the patients were observed 14 d,28 d,and 90 d after CRRT.The effects of different kinds of replacement fluid on blood glucose of the patients were analyzed.Results There were no statistically significant differences in general information (age,sex e.g.) and blood glucose level before CRRT between the two groups,or blood glucose level 24 h after CRRT (P>0.05).The blood glucose level 72 h after CRRT in the sugar-containing group was higher than that in the sugar-free group[(9.39±3.13) mmol/L vs.(7.57±2.86) mmol/L],with statistically significant difference(P<0.05).There were no statistically significant differences in APACHE score 72 h after CRRT,death rate 14 d,28 d,and 90 d after CRRT between the two groups (P>0.05).Conclusions CRRT sugar-containing replacement fluid has significant effect on blood glucose in patients with AKI after cardiac surgery in 72 h;we must monitor the blood glucose level closely within 72 h after CRRT with sugar-containing replacement fluid.Compared with sugar-free replacement fluid,sugar-containing replacement fluid does not significantly affect blood glucose and prognosis of patients.