介入时机对CRRT治疗脓毒症致AKI的疗效影响

Influence of interventional timing on effect of CRRT in treating sepsis-induced AKI

目的比较不同介入时机的连续性肾脏替代治疗(CRRT)治疗脓毒症致急性肾损伤(AKI)的临床疗效。方法选择2018年3月至2020年2月收治的120例脓毒症致AKI患者,分为早期肾脏替代治疗(RRT)组(n=61,RIFLE受损期启动CRRT)与延迟RRT组(n=59,RIFLE衰竭期启动CRRT)。比较两组28 d死亡率和治疗5 d后肾功能指标[血肌酐(Scr)、血尿素氮(BUN)]、炎性指标[白细胞计数(WBC)、降钙素原(PCT)、白细胞介素-6(IL-6)]和疾病严重程度评分[序贯器官衰竭(SOFA)评分、急性生理与慢性健康(APACHEⅡ)评分]。结果早期RRT组治疗5 d后Scr、BUN、IL-6水平及第28天死亡率均低于延迟RRT组,差异有统计学意义(P<0.05)。结论早期CRRT可以有效缓解脓毒症患者的肾脏损伤程度。

Objective To compare the clinical effects of different interventional timing of continuous renal replacement therapy(CRRT)in the treatment of acute kidney injury(AKI)caused by sepsis.Methods A total of 120 patients with sepsis-induced AKI admitted and treated from March 2018 to February 2020 were selected and divided into the early renal replacement therapy(RRT)group(n=61,CRRT was initiated during the RIFLE impaired period)and delayed RRT group(n=59,CRRT was initiated during the RIFLE failure period).The 28 d mortality rate and renal function indexes[serum creatinine(Scr),blood urea nitrogen(BUN)],inflammation indexes[white blood cell count(WBC),procalcitonin(PCT),interleukin-6(IL-6)]and disease severity score[sequential organ failure(SOFA)score,acute physiology and chronic health(APACHEⅡ)score]after 5 d treatment were compared between the two groups.Results The levels of Scr,BUN,IL-6 after 5 d treatment and the 28 d mortality rate in the early RRT group were lower than those in the delayed RRT group,the difference was statistically significant(P<0.05).Conclusion Early CRRT can effectively alleviate the degree of kidney damage in the patients with sepsis.