脓毒血症伴急性肾损伤肾脏替代治疗时机的探讨

Timing of renal replacement therapy for sepsis with acute kidney injury

目的:探讨脓毒血症伴急性肾损伤肾脏替代治疗的最佳治疗时机及疗效。方法:选取我院2017年1月至2019年6月期间收治的90例脓毒血症伴急性肾损伤患者,按照治疗时机的不同分为两组,观察组(45例)于48 h内启动持续肾脏替代疗法(CRRT)治疗,对照组(45例)于晚期启动CRRT,对两组治疗效果进行比较。结果:治疗半个月、1个月后,观察组存活率均显著高于对照组(P<0.05),观察组APACHEⅡ评分均显著显低于对照组(P<0.01);治疗3个月后,观察组血肌酐、尿量、IL-1β改善情况优于对照组(P<0.01);观察组心血管事件发生率低于对照组(P<0.05)。结论:早期予以脓毒血症伴急性肾损伤患者CRRT效果理想,有利于改善患者炎症反应,稳定患者内环境,提高患者存活率。

Objective:To explore the best timing of renal replacement therapy for sepsis with acute kidney injury and its curative effect.Methods:90 patients with sepsis and acute kidney injury admitted to our hospital from January 2017 to June 2019 were divided into two groups according to the timing of treatment.45 patients in the observation group were treated by continuous renal replacement therapy(CRRT)within 48 hours.45 patients in the control group were treated by CRRT in the late stage.The therapeutic effects were compared between the two groups.Results:The survival rate in the observation group was significantly higher than that in the control group(P<0.05)after half a month and one month of treatment;the APACHEⅡscore in the observation group was significantly lower than that in the control group(P<0.01)after half a month and one month of treatment;after three months of treatment,the improvement of serum creatinine,urine volume and IL-1βin the observation group was better than that in the control group(P<0.01);the incidence of cardiovascular events in the observation group was lower than that in the control group(P<0.05).Conclusion:Early CRRT for sepsis patients with acute kidney injury is effective,which can improve the inflammatory reaction,stabilize the internal environment,and improve the survival rate of patients.