连续性肾脏替代治疗时机对脓毒症相关急性肾损伤患者28天预后的影响  

Impact of timing of continuous renal replacement therapy on 28-day outcomes in patients with sepsis-associated acute kidney injury

作　　者：李青霖[1] 胡新[1] 毛智[1] 齐霜 康红军[1] 周飞虎[1,2] LI Qing-Lin;HU Xin;MAO Zhi;QI Shuang;KANG Hong-Jun;ZHOU Fei-Hu(Department of Critical Care Medicine,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心重症医学科,北京100853 [2]解放军总医院国家老年疾病临床医学研究中心,北京100853

出　　处：《中华老年多器官疾病杂志》2019年第9期651-655,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：北京市科技计划课题(Z161100000116054);国家老年疾病临床医学研究中心课题(NCRCG-PLAGH-2017008)~~

摘　　要：目的探讨重症监护病房(ICU)中脓毒症相关急性肾损伤(SI-AKI)患者临床特点及连续性肾脏替代治疗(CRRT)时机对28d预后的影响。方法回顾性分析2017年6月至2018年12月解放军总医院第一医学中心重症医学科SI-AKI患者44例,根据AKI发生48h内是否行CRRT分为早期CRRT组29例和晚期CRRT组15例,比较2组患者各项生理功能指标及28d预后情况。应用SPSS17.0统计软件对数据进行分析。Kaplan-Meier生存分析患者28d预后。结果根据KDIGO分期标准,AKI1期13.6%(6/44),2期18.2%(8/44),3期68.2%(30/44)。短暂性AKI占18.2%(8/44),持续性AKI占81.8%(36/44)。AKI发生28d时15例死亡。早期CRRT组相比晚期CRRT组患者糖尿病比例(31.0%和6.7%,P=0.048)高,CRRT时收缩压[(114±15)和(130±20)mmHg(1mmHg=0.133kPa),P=0.005]、平均动脉压[(82±11)和(91±18)mmHg,P=0.040]、血肌酐(197.0和418.9μmol/L,P=0.002)、尿素氮(12.9和35.0mmol/L,P<0.001)、血钙(1.9和2.0mmol/L;P=0.007)、血镁(0.7和0.8mmol/L,P=0.013)水平低,血红蛋白[(96±26)和(84±13)g/L,P=0.046]及血乳酸(3.8和1.7mmol/L,P=0.009)水平高,AKI3期患者比例(58.6%和86.7%,P=0.041)低。早期CRRT组患者28d病死率31%(9/29),晚期CRRT组患者28d病死率40%(6/15),2组比较差异无统计学意义(P=0.575)。结论早期CRRT没有明显改善SI-AKI患者28d病死率。Objective To investigate the clinical characteristics of sepsis-associated acute kidney injury (SI-AKI) patients in intensive care unit (ICU) and the impact of timing of continuous renal replacement therapy (CRRT) on 28-day prognosis in them.Methods A retrospective analysis was made on 44 SI-AKI patients hospitalized in Department of Critical Care Medicine,the First Medical Center of Chinese PLA General Hospital from June 2017 to December 2018.According to whether CRRT was performed within 48 h after the occurrence of AKI,29 patients were assigned into the early CRRT group,and the other 15 patients into the late CRRT group.Their physiological indicators and 28-day outcomes were compared between the 2 groups.SPSS statistics 17.0 was used to perform the statistical analysis.Kaplan-Meier survival analysis was employed to analyze the 28-day prognosis of the patients.Results According to the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline,there were 6(13.6%) patients at AKI stage 1,8(18.2%) at stage 2,and 30(68.2%) at stage 3.The patients having transient AKI accounted for 18.2%(8/44),and persistent AKI for 81.8%(36/44).Within 28 d after AKI occurrence,15 cases died.The early CRRT group had a higher proportion of diabetes mellitus (31.0% vs 6.7%,P =0.048),and obviously lower levels of systolic blood pressure [(114±15) vs (130±15)mmHg,P =0.005 ] during the process of CRRT,mean arterial pressure [(82±11) vs (91±18)mmHg,P =0.040],serum creatinine (1.97.0 vs 418.9 μmol/L,P =0.002,),urea nitrogen (12.9 vs 35.0 mmol/L,P <0.001),serum calcium (1.9 vs 2.0 mmol/L,P =0.007 ),serum magnesium (0.7 vs 0.8 mmol/L,P =0.013),elevated serum levels of hemoglobin [(96±26) vs (84±13)g/L,P =0.041 ] and lactic acid (3.8 vs 1.7 mmol/L,P =0.009),and lower proportion of those at AKI stage 3 (58.6% vs 86.7%,P =0.041 ),when compared with the late CRRT group.The 28-day mortality was 31%(9/29) in the early CRRT group,and 40%(6/15) in late CRRT group,and there was no significant difference between the 2 groups

关 键 词：脓毒症 急性肾损伤 连续性肾脏替代治疗 预后 

分 类 号：R631[医药卫生—外科学]