连续性肾脏替代治疗在治疗高龄脓毒症合并急性肾损伤患者的作用  

The effect of continuous renal replacement therapy to treat sepsis associated acute kidney injury in very elderly patients

作　　者：马冠华 李向阳[1] 周伊南[1] 龚瑾[1] 浦瑾 朱惠莉[1] MA Guanhua;LI Xiangyang;ZHOU Yinan;GONG Jin;PU Jin;ZHU Huili(Department of Respiratory Medicine and Critical Care Medicine,Huadong Hospital,Shanghai Fudan University,Shanghai 200040,P.R.China)

机构地区：[1]复旦大学附属华东医院呼吸与危重症医学科,上海200040

出　　处：《中国呼吸与危重监护杂志》2020年第5期463-466,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的研究连续性肾脏替代治疗(CRRT)在治疗高龄脓毒症合并急性肾损伤(AKI)患者的作用。方法回顾性分析上海华东医院老年科呼吸监护病房2013年1月至2018年7月住院脓毒症合并AKI患者的临床资料,其中男38例,女3例,平均年龄(92.3±8.8)岁。所有脓毒症合并AKI患者均给予抗感染、液体复苏等治疗,经综合判断有肾脏替代指征后行CRRT治疗,根据是否可行CRRT治疗分组:CRRT组,20例;对照组,21例。比较两组患者的一般临床情况、生存时间及28天死亡率,诊断当天急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分、外周血白细胞计数(WBC)、中性粒细胞计数(NEU)、血红蛋白含量(HB)、血小板计数(PLT)的差异;两组间及治疗前后血清尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、胱抑素C、C反应蛋白(CRP)、降钙素原(PCT)的变化。结果两组之间的男女构成比、基础疾病比例、年龄、体质指数、APACHEⅡ评分、SOFA评分、WBC、NEU、HB、PLT、生存时间比较,差异均无统计学意义(均P>0.05),CRRT组较对照组患者28天死亡率降低(P<0.05)。CRRT组治疗3 d后较起病时血清UA及CRP降低,差异有统计学意义(均P<0.05),对照组治疗3 d后较起病时血清BUN、Cr、UA、胱抑素C均升高,差异有统计学意义(均P<0.05)。两组间起病时血清BUN、Cr、UA、胱抑素C、CRP、PCT差异均无统计学意义(均P>0.05),治疗3 d后CRRT组较对照组血清PCT、BUN、Cr、UA降低,差异有统计学意义(均P<0.05)。结论高龄脓毒症合并AKI患者给予CRRT治疗可以改善患者高尿酸血症,控制肾功能指标恶化,降低早期全身炎症反应及28天死亡率。Objective To explore the effect of continuous renal replacement therapy(CRRT)to treat sepsis associated acute kidney injury(AKI)in patients aged over 80.Methods Forty-one patients diagnosed with sepsis and AKI were enrolled in geriatric RICU department of Huadong Hospital from January 2013 to July 2018,38 patients were male and 3 were female.All patients were treated with anti-infection and fluid resuscitation therapy.After comprehensive judgment of the indication of renal replacement,they were divided into two groups by the choices of using CRRT.There were 20 patients in CRRT group and 21 in control group.Clinical data such as age,body mass index,previous diseases,28-day mortality rate,blood cells,APACHEⅡas well as SOFA scores were compared between two groups.Blood renal function and inflammatory markers at the first day were also compared to those after 3-day treatment of initial time.Results No statistical difference was observed in sex ratio,age,body mass index and previous diseases between two groups(all P>0.05).There was also no difference in APACHEⅡscore,SOFA score,blood cells,hemoglobin and survival time.The 28-day mortality rate in CRRT group was lower than that in control group(P<0.05).The levels of serum UA and C reactive protein(CRP)in CRRT group decreased after 3-day treatment compared with those at the onset,and the differences were statistically significant(all P<0.05).The level of serum blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA)and cystain C in control group increased after 3 days compared with those at the onset,and the difference were statistically significant(all P<0.05).There was no significant difference in serum BUN,Cr,UA,cystain C,CRP and procalcitonin(PCT)between two groups at the onset(all P>0.05).After 3 days of CRRT,the levels of serum PCT,BUN,Cr and UA in CRRT group were lower than those in the control group(all P<0.05).Conclusion CRRT can improve hyperuricemia,control deterioration of renal function,reduce early systemic inflammatory response and 28-day mortality rate i

关 键 词：脓毒症 急性肾功能损伤 高龄老人 连续性肾脏替代治疗 炎症 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]