重症急性胰腺炎合并急性肾损伤的连续性肾替代治疗开始时机  

The initiation time of continuous renal replacement therapy for severe acute pancreatitis patients complicated with acute kidney injury

作　　者：韩莉[1] 张凌[2] 康焰[1] 

机构地区：[1]四川大学华西医院重症医学科,成都610041 [2]四川大学华西医院肾内科,成都610041

出　　处：《中国血液净化》2015年第8期486-489,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨重症急性胰腺炎（severe acute pancreatitis，SAP）合并急性肾损伤（acute kidney injury，AKI）时连续性肾替代治疗（continuous renal replacement therapy ，CRRT）开始时机。方法回顾性分析2010～2013年合并 AKI 的SAP 患者病例资料，根据KDIGO的 AKI1～3期分级标准将患者分为开始CRRT早（AKI1、2期）和开始晚（AKI 3期）2组，比较患者人口学特征，开始CRRT时的临床数据，预后指标是60天ICU住院病死率和ICU住院时间。结果84例合格患者纳入分析，早期开始CRRT组27例，晚期CRRT组57例。早晚2组的60天ICU住院病死率分别为为30%（9/27）和59.3%（32/57），差异具有统计学意义（c2=6.608，P =0.010）；并且开始早的患者的ICU住院时间更短[HR：0.392（95% CI：0.169～0.776），P =0.009]。结论合并AKI的SAP患者的CRRT宜在AKI早期（1和2期）开始。Objective To explore the initiation time of continuous renal replacement therapy （CRRT） for severe acute pancreatitis （SAP） patients complicated with acute kidney injury （AKI）. Methods SAP pa-tients with AKI admitted to West China Hospital of Sichuan University and received CRRT during the period from Jan. 2010 to Dec. 2013 were retrospectively analyzed. They were divided into early CRRT group （initiat-ed at AKI stage 1 or 2） and late CRRT group （initiated at AKI stage 3）. Demographic information and clinical data at the initiation of CRRT, and prognosis including the 60~day-ICU mortality and the retained days in ICU were compared between the two groups. Results A total of 84 patients were analyzed, 30 patients in the early CRRT group and 57 patients in the late CRRT group. The 60-day-ICU mortality was 30% （9/27） in the early CRRT group and was 59.3% （32/57） in the late CRRT group （c2=6.608, P=0.010）. The retained days in ICU was shorter in the early CRRT group than in the late CRRT group （HR=0.392, 95% CI： 0.169~0.776;P=0.009）. Conclusion CRRT performed at the early stage （at AKI stage 1 or 2） may be optimal for the treat-ment of SAP patients complicated with AKI.

关 键 词：重症胰腺炎 急性肾损伤 连续性肾替代治疗 开始时机 

分 类 号：R492.5[医药卫生—康复医学]