急性肾损伤2期与3期连续肾脏替代治疗对危重急性肾损伤患者预后的影响比较

Comparison of effect of continuous renal replacement therapy in AKI 2 stage and AKI 3 stage on the prognosis of critical patients with acute kidney injury

目的比较急性肾损伤(AKI)2期与AKI 3期连续肾脏替代治疗(CRRT)对危重AKI患者预后的影响。方法以2017年2月至2018年10月在本院ICU实施CRRT的56例危重AKI 2~3期患者为研究对象,按照2012年国际改善全球肾脏病预后组织(KDIGO)制订的新的AKI标准,将患者分为AKI 2期组(26例)与AKI 3期组(30例)。比较两组的预后指标(住院时间、CRRT持续时间、28 d肾功能恢复率、28 d全因病死率)及治疗前后的急性生理学和慢性健康状况Ⅱ(APACEⅡ)评分,采用Kaplan-Meier法对两组进行生存分析。结果AKI 3期组患者的CRRT持续时间[(188.6±112.5)h vs.(96.3±44.7)h]、28 d全因病死率[66.7%(20/30)vs.15.4%(4/26)]均明显高于AKI 2期组(P<0.05),28 d肾功能恢复率[36.7%(11/30)vs.92.3%(24/26)]均明显低于AKI 2期组(P<0.05);治疗后,两组患者APACEⅡ评分均明显降低(P<0.05),AKI 3期组患者的APACEⅡ评分[(23.4±3.6)分vs.(19.8±2.1)分]明显高于AKI 2期组(P<0.05);AKI 3期组患者的生存中位时间(34 d vs.109 d)明显短于AKI 2期组(P<0.05)。结论AKI 2期启动CRRT能够明显降低28 d全因病死率,延长生存中位时间,改善患者的健康状况。

Objective To compare the effect of continuous renal replacement therapy(CRRT)in AKI 2 stage and AKI 3 stage on the prognosis of critical patients with acute kidney injury(AKI).Methods From February 2017 to October 2018,56 cases of critical patients with AKI 2-3 stage who underwent CRRT in ICU of our hospital were selected as the research objects.According to the new AKI criteria formulated by the international organization for improving the prognosis of global kidney disease(KDIGO)in 2012,the patients were divided into AKI 2 stage group(n=26)and AKI3 stage group(n=30).The prognostic indexes(length of hospital stay,duration of CRRT,renal function recovery rate in 28 days,all-cause mortality in 28 days)were compared between two groups.The acute physiology and chronic healthⅡ(APACEⅡ)scores were compared between two groups before and after treatment.Survival analysis was performed by Kaplan-Meier in two groups.Results The duration of CRRT[(188.6±112.5)h vs.(96.3±44.7)h],all-cause mortality in 28 d[66.7%(20/30)vs.15.4%(4/26)]of AKI 3 stage group was significantly higher than that of AKI 2 stage group(P<0.05)and the renal function recovery rate in 28 days[36.7%(11/30)vs.92.3%(24/26)]of AKI 3 stage group was significantly lower than that of AKI 2 stage group(P<0.05).After treatment,the APACEⅡscores were significantly reduced in two groups(P<0.05)and the APACEⅡscores[(23.4±3.6)scores vs.(19.8±2.1)scores]of the AKI 3 stage group was significantly higher than that of AKI 2 stage group(P<0.05).The median survival time(34 days vs.109 days)of AKI 3 stage group was significantly shorter than that of AKI 2 stage group(P<0.05).Conclusions CRRT initiation in AKI 2 stage could significantly reduce all-cause mortality in 28 days,prolong the median survival time and improve the health condition of patients.