连续性肾脏替代新生儿脓毒血症相关性急性肾损伤的临床研究

Clinical study on continuous renal replacement therapy in neonatal sepsis-related acute kidney injury

目的探讨连续性肾脏替代治疗(CRRT)在新生儿脓毒血症相关性急性肾损伤(AKI)治疗中的应用价值。方法本研究回顾性分析2017年6月至2021年8月泉州市儿童医院新生儿科诊治的脓毒血症相关性AKI新生儿26例,均予以CRRT,观察CRRT治疗持续时间、住院时间,并发症、28 d存活率;治疗前、治疗12 h、24 h、48 h及治疗结束后平均动脉压(MAP)、pH值、氧合指数及乳酸、血肌酐、尿素氮、胱抑素C、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、Toll样受体4(TLR4)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL),采用单因素重复测量方差分析比较治疗后不同时间临床指标的变化。结果26例脓毒血症相关性AKI新生儿均顺利完成连续性肾脏替代,28 d存活率88.46%(23/26)。CRRT治疗持续时间为(73.52±12.65)h、住院时间(10.25±2.32)d。CRRT治疗12 h、24 h、48 h及治疗结束后的MAP、氧合指数、pH值高于治疗前,尿量多于治疗前,而乳酸、血肌酐、尿素氮、胱抑素C、TNF-α、IL-6、TLR4、NGAL均低于治疗前,差异具有统计学意义(P<0.05)。CRRT治疗期间出现低血压4例(15.38%)、低体温3例(11.54%)、导管堵塞3例(11.54%)。7例患儿的7 d新生儿神经行为测定(NBNA)评分<35分,2例出现Vojta异常姿势反射。结论CRRT治疗新生儿脓毒血症相关性AKI具有较为理想的效果,能有效降低炎性因子及纠正水电解质紊乱,避免肾脏进一步损伤,且安全性较好,但存在远期脑损伤风险,临床还需提高关注度。

Objective To investigate the application value of continuous renal replacement therapy(CRRT)in the treatment of neonatal sepsis-associated acute kidney injury(AKI).Methods A total of 26 neonates with sepsis-associated AKI diagnosed and treated from June 2017 to August 2021 were selected for retrospective analysis.All of them were given CRRT;observe the duration of CRRT treatment,length of hospital stay,complications and 28 d survival rate.The following indexes before treatment,at 12 h,24 h and 48 h after treatment as well as at the end of the treatment were also recorded:mean arterial pressure(MAP),pH value,oxygenation index,lactic acid,serum creatinine(Scr),blood urea nitrogen(BUN),cystatin C(CysC),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),Toll-like receptor 4(TLR4),and neutrophil gelatinase-associated lipocalin(NGAL).The one-way repeated measures ANOVA was used to analyze the changes in the clinical indexes at different treatment time.Results Continuous renal replacement was successfully completed in 26 neonates with sepsis-associated AKI,with a survival rate of 88.46%(23/26)at 28 days.The duration of CRRT treatment was(73.52±12.65)h and the duration of hospitalization was(10.25±2.32)d.MAP,oxygenation index,and pH at 12 h,24 h,48 h and at the end of treatment were higher than those before treatment,and urine volume was more than before treatment,while lactic acid,Scr,BUN,CysC,TNF-α,IL-6,TLR4 and NGAL were all lower than before treatment,and the differences were statistically significant(P<0.05).There were 4 cases of hypotension(15.38%),3 cases of hypothermia(11.54%)and 3 cases of catheter blockage(11.54%)during the treatment of CRRT.The 7 d NBNS score of 7 patients was less than 35 points,and 2 patients had abnormal Vojta postural reflex.Conclusion CRRT has ideal effects and is safe in the treatment of neonatal sepsis-related AKI,which can effectively reduce inflammatory factors,correct water and electrolyte disorders,and avoid further kidney damage,but there is a risk of long-term brain injury,and clinical attention should be paid to it.