比较平衡盐溶液与生理盐水对脓毒症患者急性肾损伤的影响

Effects of balanced salt solution and normal saline on acute kidney injury in sepsis patients

目的比较平衡盐溶液与生理盐水对脓毒症患者急性肾损伤的影响。方法前瞻性选取2019年2-8月山西医科大学第一医院重症医学科(ICU)收治的90例脓毒症患者,随机分为试验组和对照组,每组45例。试验组给予平衡盐溶液(钠钾镁钙葡萄糖注射液)用于液体复苏治疗,对照组给予生理盐水,连续用药5 d,余常规治疗不予干预。比较两组患者用药期间肾功能情况、急性生理学和慢性健康状况评分(APACHEⅡ评分)、序贯器官衰竭估计评分(SOFA评分)、急性肾损伤(AKI)发生率、高氯血症发生率、连续肾脏替代疗法(CRRT)使用时间、有创呼吸机使用时间、住ICU时间及住院时间、研究液使用量、用药结束后28 d生存率等。结果试验组高氯血症发生率、AKI发生率明显低于对照组,差异有统计学意义(P<0.05);试验组CRRT使用时间、有创呼吸机使用时间、住ICU时间及住院时间等短于对照组,差异有统计学意义(P<0.05);试验组血清肌酐下降程度整体优于对照组,入组第2天(D2)和第3天(D3)两组比较差异有统计学意义(P<0.05);试验组SOFA评分改善、APACHEⅡ评分改善明显优于对照组,差异有统计学意义(P<0.05);两组研究液使用量比较,差异无统计学意义(P>0.05);试验组28 d生存率明显高于对照组,差异有统计学意义(P<0.05)。结论使用平衡盐溶液用于脓毒症患者的液体复苏,可有效降低入住ICU脓毒症患者的AKI发生率,且能够有效减轻入住ICU时已经合并AKI患者的肾损伤程度,延缓患者病情进展,缩短住院日,改善预后。

Objective To compare the effect of balanced salt solution and normal saline on acute kidney injury in sepsis patients.Methods Totally 90 patients with sepsis admitted to ICU of the First Hospital of Shanxi Medical University from February 2019 to August 2019 were randomly divided into experiment group and control group with 45 cases in each group.Experiment group was given balanced salt solution(sodium,potassium,magnesium,calcium and glucose injection),for fluid resuscitation treatment,while control group was given normal saline(0.9%NaCl injection),for 5 consecutive days.The rest of the routine treatment was not intervened.The renal function,acute physiology and chronic health score(APACHEⅡscore),sequential organ failure assessment score(SOFA score),incidence of acute kidney injury(AKI),incidence of hyperchloremia,duration of continuous renal replacement therapy(CRRT),use time of invasive ventilator,length of stay in ICU and length of stay in hospital,study liquid usage,and 28 days survival rate after medication were compared between the two groups.Results The incidence of hyperchloremia and AKI in experiment group was significantly lower than that in control group(P<0.05);the time of CRRT using and invasive ventilator,and length of ICU and hospital stay in experiment group were shorter than those in control group,the differences being statistically significant(P<0.05);the decrease of serum creatinine in experiment group was better than that in control group as a whole,and there was significant difference between the two groups on the second day(D2)and the third day(D3)(P<0.05);comparing the improvement in SOFA score and ApacheⅡscore,experiment group was significantly better than control group,the difference being statistically significant(P<0.05);there was no significant difference between the two groups in the amount of the study liquid usage(P>0.05);the 28-day survival rate of experiment group was significantly higher than that of control group(P<0.05).Conclusion The use of balanced salt solution for fluid resuscitation in sepsis patients can effectively reduce the incidence of AKI in ICU patients with sepsis,and can effectively reduce the degree of renal injury in ICU patients with AKI,delay the progress of the disease,shorten the length of hospital stay and improve the prognosis.