早期与晚期CRRT治疗对脓毒症合并急性肾损伤患者肾功能、免疫功能及预后的影响对比

Comparison of the Effects of Early and Late CRRT Treatment on Renal Function,Immune Function and Prognosis in Patients with Sepsis Complicated with Acute Kidney Injury

目的探究早期与晚期连续性肾脏替代疗法(CRRT)治疗对脓毒症合并急性肾损伤患者的影响。方法选取旅顺口区人民医院2021年1月—2023年11月收治的60例脓毒症合并急性肾损伤患者为研究对象,采用随机数字表法将其分为对照组和观察组,每组30例。对照组采用晚期CRRT治疗,观察组采用早期CRRT治疗。对比两组患者的预后转归情况、肾功能、炎性指标、免疫功能。结果观察组的住院、ICU治疗时间均短于对照组,28 d病死率为13.33%,低于对照组的30.00%,组间差异有统计学意义(P<0.05)。治疗7 d后,观察组的尿肾损伤分子-1、血清肌酐、中性粒细胞明胶酶相关脂质运载蛋白、尿素氮水平均低于对照组,组间差异有统计学意义(P<0.05);观察组的C反应蛋白、降钙素原、白细胞介素-6水平均低于对照组,组间差异有统计学意义(P<0.05);观察组的免疫球蛋白A、免疫球蛋白G、免疫球蛋白M水平均高于对照组,组间差异有统计学意义(P<0.05)。结论相较于晚期CRRT治疗,脓毒症合并急性肾损伤患者接受早期CRRT治疗的效果更佳,可减轻炎性反应,改善免疫功能、肾功能,促进预后转归。

Objective To investigate the effect of early and late continuous renal replacement therapy(CRRT)on patients with sepsis complicated with acute kidney injury.Methods Sixty patients with sepsis complicated with acute kidney injury admitted to People's Hospital of Lvshunkou District from January 2021 to November 2023 were selected as the research objects,and were divided into a control group and an observation group by random number table method,with 30 cases in each group.The control group was treated with late CRRT and the observation group was treated with early CRRT.The prognosis,renal function,inflammatory indexes and immune function of the two groups were compared.Results The hospitalization and ICU treatment time in the observation group,which were shorter than those in the control group,and the mortality rate at 28 days was 13.33%,which was lower than 30.00%in the control group,and the differences between the groups were statistically significant(P<0.05).After 7 days of treatment,the levels of kidney injury molecule 1,serum creatinine,neutrophil gelatinase-associated lipocalin and blood urea nitrogen in the observation group,which was lower than those in the control group,and the differences between the groups were statistically significant(P<0.05);the levels of C-reactive protein,procalcitonin and interleukin 6 in the observation group,which was lower than those in the control group,and the differences between the groups were statistically significant(P<0.05);the levels of immunoglobulin A,immunoglobulin G and immunoglobulin M in the observation group,which were higher than those in the control group,and the differences between the groups were statistically significant(P<0.05).Conclusion Compared with late CRRT treatment,early CRRT treatment in patients with sepsis complicated with acute kidney injury is more effective,which can reduce inflammatory response,improve immune function and renal function,and promote prognosis.