新型冠状病毒肺炎重症患者合并急性肾损伤的发病机制及用药建议

Pathogenesis and Medication Recommendations of Acute Kidney Injury in Patients with Severe Coronavirus Disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)重症患者合并急性肾损伤(AKI)的发病机制,保障肾功能损伤患者的用药安全。方法结合COVID-19重症患者的临床特征及AKI的常见病因,分析可能的发病机制,并归纳依据肌酐清除率对肾功能损伤患者的用药调整。结果COVID-19重症患者以发热、咳嗽为主要表现,伴有外周血淋巴细胞减少、炎症因子水平升高、肝肾功能障碍,以及细胞免疫功能下降,其发生机制可能与缺血再灌注损伤、药物、脓毒症相关。应加强治疗相关的抗病毒药物与抗菌药物的合理使用。结论尽早识别并纠正肾功能损伤的可逆病因,加强抗病毒药物及抗菌药物的合理应用,有助于缩短病程,改善预后。

Objective To investigate the pathogenesis of acute kidney injury(AKI)in patients severe with coronavirus disease 2019(COVID-19),and ensure the medication safety for patients with renal impairment.Methods According to the clinical characteristics of patients with severe COVID-19 and the common causes of AKI,the possible pathogenesis was analyzed,and the medication adjustment for patients with renal impairment was summarized according to creatinine clearance rate.Results The main clinical manifestations of patients with severe COVID-19 were fever and cough,accompanied by decreased peripheral blood lymphocytes,increased inflammatory factors,dysfunctional liver and kidney,and decreased cellular immune function.The mechanism may be related to ischemia-reperfusion injury,drugs and sepsis.The rational use of related antiviral and antibacterial drugs should be strengthened.Conclusion Identifying and correcting the reversible cause of renal impairment as early as possible,and strengthening the rational use of antiviral and antibacterial drugs can help shorten the course of disease and improve the prognosis.