KDIGO-AKI分期标准在急性心力衰竭治疗中指导CRRT启动时机的临床意义

Role of acute kidney injury staging by KDIGO criteria in guiding the CRRT initiation in the treatment of acute heart failure

目的探讨KDIGO-AKI分期标准在急性心力衰竭(AHF)治疗中指导CRRT启动时机的临床意义。方法通过回顾分析本院重症医学科2014年6月至2019年6月收治的114例诊断为急性心力衰竭并发急性肾功能不全、接受CRRT治疗患者的临床资料,采用改善全球肾病预后组织的AKI分期标准(KDIGO标准)对CRRT治疗的时机进行分组,分为KDIGO 1级组、KDIGO 2级组及KDIGO 3级组,急诊透析患者归为急诊CRRT组,分析不同的CRRT治疗启动时期对存活率、肾功能改善情况、CRRT治疗时长、呼吸机辅助通气时间、ICU住院时间的影响。结果KDIGO 1、2级组与KDIGO 3级组及急诊CRRT组比较,存活率高[KDIGO 1、2级组69.05%(29/42);KDIGO 3级组21.88%(7/32);急诊CRRT组42.05%(17/40)](均P<0.05)。KDIGO 1、2级组存活患者肾功能改善率显著高于KDIGO 3级组及急诊CRRT组[KDIGO 1、2级组51.72%(15/29);KDIGO 3级组42.86%(3/7);急诊CRRT组35.29%(6/17)](均P<0.05)。KDIGO 1、2级组呼吸机辅助通气时间少于KDIGO 3级组(P<0.05),CRRT治疗时长、呼吸机辅助通气时间、ICU住院时间均少于急诊CRRT组(均P<0.05);KDIGO 3级组与急诊CRRT组在3项指标比较中差异均无统计学意义(均P>0.05)。结论AHF合并AKI治疗中,与急诊透析标准作为启动CRRT时机相比,KDIGO 1、2级期给予CRRT治疗,可提高患者生存率,改善生存患者肾功能,也可减少CRRT治疗剂量、呼吸机通气时间及ICU住院时间。

Objective To investigate the role of acute kidney injury staging by KDIGO criteria in guiding the CRRT initiation in the treatment of acute heart failure.Methods A retrospective study was conducted.114 patients diagnosed as acute heart failure and acute kidney injury were treated with CRRT in ICU of our hospital from June 2014 to June 2019.According to the Criteria of Kidney Disease:Improving Global Outcomes Organization(KDIGO standard),the patients were stratified into KDIGO stage 1 group,KDIGO stage 2 group,KDIGO stage 3 group,and emergency CRRT group.ICU survival rate,renal function,CRRT treatment time,ventilation time,and time of ICU stay were compared among the four groups.Results Compared with KDIGO stage 3 group and emergency CRRT group,KDIGO stage 1 and 2 group had significantly higher survival rate[69.05%(29/42)vs.21.88%(7/32)vs.42.05%(17/40)](both P<0.05).The improvement rate of renal function of survivors in KDIGO stage 1 and 2 group was higher than those in KDIGO stage 3 group and emergency CRRT group[51.72%(15/29)vs.42.86%(3/7)vs.35.29%(6/17)](both P<0.05).The ventilation time of KDIGO stage 1 and 2 group was less than that in KDIGO stage 3 group(P<0.05),the CRRT treatment time,ventilation time,and time of ICU stay in KDIGO stage 1 and 2 group were less than those in emergency CRRT group(all P<0.05),no statistically significant differences in above 3 indexes between KDIGO stage 3 group and emergency CRRT group(all P>0.05).Conclusion In the treatment of patients with AHF and AKI,compared with using emergency dialysis standard as CRRT initiation standard,treatment initiation in KDIGO stage 1 and 2 can improve survival rate,recover renal function of survivors,reduce CRRT time,ventilation time,and time of ICU stay.