肾脏替代治疗时机对ICU脓毒症致肾损伤患者预后的影响

Effects of renal replacement therapy at different times on the prognosis of patients with kidney injury caused by sepsis in ICU

目的比较肾脏替代治疗时机对重症监护病房(ICU)脓毒症致肾损伤(AKI)患者预后的影响。方法回顾性选取2017年7月-2019年12月医院ICU收治的脓毒症致肾损伤患者120例,依据接受连续性肾脏替代治疗(CRRT)的时机将其分为早期组(n=57,开始CRRT治疗时AKI≤2级)、晚期组(n=63,开始CRRT治疗时AKI 3级),比较两组一般资料、治疗后主要结局指标及28 d生存率、总病死率、并发症发生率。结果早期组治疗前序贯器官衰竭评分(SOFA)、白细胞计数(WBC)低于晚期组(P<0.05);早期组CRRT治疗时间(12.41±1.48)d、ICU住院时间(11.41±1.24)d短于晚期组(16.14±1.65)d、(13.57±1.42)d,早期组治疗后氧合指数(206.41±21.48)、肾功能恢复率91.23%,高于晚期组(156.71±16.23)、77.78%(P<0.05);早期组28 d病死率33.33%低于晚期组52.38%(P<0.05);早期组酸中毒发生率1.75%低于晚期组14.29%(P<0.05)。结论 ICU脓毒症致AKI患者预后较差,CRRT的治疗时机应选择早于肾功能进展至AKI 3级时,早期治疗有利于改善患者的近期预后,降低28 d病死率,促进肾功能恢复,减少CRRT相关并发症。

OBJECTIVE To compare the effects of renal replacement therapy at different times on the prognosis of patients with kidney injury(AKI) caused by sepsis in the intensive care unit(ICU). METHODS Total of 120 patients with kidney injury caused by sepsis, who were admitted to ICU of the hospital between Jul. 2017 and Dec. 2019 were retrospectively analyzed. According to the time of receiving continuous renal replacement therapy(CRRT), the subjects were divided into the early group(n=57, AKI≤grade 2 at the beginning of CRRT) and late group(n=63, AKI of grade 3 at the beginning of CRRT). The general data, main outcome indexes after treatment, 28-day survival rate, total mortality and incidence of complications were compared between the two groups. RESULTS Before the treatment, the Sequential Organ Failure Assessment(SOFA) scores, white blood cell count(WBC) in the early group were significantly lower than that in the late group(P<0.05). The duration of CRRT and length of ICU stay in the early group [(12.41±1.48)d,(11.41±1.24)d] were significantly shorter than that in the late group [(16.14±1.65)d,(13.57±1.42)d]. After the treatment, the oxygenation index and the recovery rate of renal function in the early group [(206.41±21.48), 91.23%] were significantly higher than that in the late group [(156.71±16.23), 77.78%](P<0.05). The 28-day mortality rate and incidence of acidosis in the early group(33.33%, 1.75%) were significantly lower than that in the late group(52.38%, 14.29%)(P<0.05). CONCLUSION The prognosis of patients with AKI caused by sepsis in ICU is poor. The timing of CRRT should be chosen in patients before their renal function progressing to AKI stage 3. Early treatment can improve the patient′s short-term prognosis, reduce the 28-day mortality, promote renal function recovery, and reduce CRRT related complications.