CRRT启动时机与脓毒症相关性AKI患者预后的关系  

Relationship between the timing of initiation of continuous renal replacement therapy and the prognosis of patients with sepsis-associated acute kidney injury

作　　者：吴相伟[1] 叶继辉[1] 孙敏[1] 王志宇[1] 陈强 朱建华[1] Wu Xiangwei;Ye Jihui;Sun Min;Wang Zhiyu;Chen Qiang;Zhu Jianhua(Department of Critical Care Medicine,Ningbo First Hospital,Ningbo 315010,Zhejiang,China)

机构地区：[1]宁波市第一医院重症医学科,浙江宁波315010

出　　处：《中华危重病急救医学》2020年第11期1352-1355,共4页Chinese Critical Care Medicine

基　　金：浙江省医药卫生科技计划项目(2017KY134,2018KY669);浙江省中医药科技计划项目(2019ZA113)。

摘　　要：目的探讨连续性肾脏替代治疗(CRRT)启动时机与脓毒症相关性急性肾损伤(SA-AKI)患者预后的关系。方法回顾性分析2017年1月至2019年11月入住宁波市第一医院重症监护病房(ICU)进行CRRT的SA-AKI患者临床资料。将改善全球肾脏病预后组织(KDIGO)诊断急性肾损伤(AKI)1、2期启动CRRT的患者纳入早期治疗组,将AKI 3期启动CRRT的患者纳入晚期治疗组,对比分析两组患者的一般临床资料、ICU住院时间、总住院时间、28 d和90 d病死率、CRRT持续时间、28 d和90 d肾脏替代治疗(RRT)脱离率、存活患者中28 d和90 d RRT依赖率等指标。采用Kaplan-Meier生存曲线分析两组患者90 d累积生存率。结果共入选244例行CRRT的SA-AKI患者,其中早期治疗组71例,晚期治疗组173例。两组在年龄、性别构成、急性生理学与慢性健康状况评分(APACHEⅡ)、手术患者比例、感染部位、抗凝方案等方面差异均无统计学意义。早期治疗组CRRT持续时间明显短于晚期治疗组〔h:26.0(12.0,49.0)比41.0(20.8,87.0),P<0.01〕,但早期治疗组与晚期治疗组在ICU住院时间、总住院时间、病死率、RRT脱离率等方面差异均无统计学意义〔ICU住院时间(d):9.0(4.0,15.0)比10.0(4.5,18.0),总住院时间(d):17.0(10.0,30.0)比18.0(10.0,32.0),28 d病死率:45.1%比48.0%,90 d病死率:46.4%比51.4%,28 d RRT脱离率:49.3%比45.1%,90 d RRT脱离率:52.1%比47.4%,均P>0.05〕;早期治疗组与晚期治疗组28 d和90 d存活患者的RRT依赖率差异也均无统计学意义〔28 d RRT依赖率:10.3%(4/39)比13.3%(12/90),90 d RRT依赖率:2.6%(1/38)比2.4%(2/84),均P>0.05〕。Kaplan-Meier生存分析提示两组90 d累积生存率比较差异无统计学意义(Log-Rank检验:χ^(2)=0.791,P=0.374)。结论SA-AKI患者早期启动CRRT治疗会减少CRRT持续时间,但对患者ICU住院时间、总住院时间、肾功能恢复及病死率等预后指标无影响。目前的数据尚不能确定CRRT的最佳治疗时机。Objective To investigate the relationship between the timing of initiation of continuous renal replacement therapy(CRRT)and the prognosis of patients with sepsis associated-acute kidney injury(SA-AKI).Methods The clinical data of SA-AKI patients undergoing CRRT in intensive care unit(ICU)of Ningbo First Hospital from January 2017 to November 2019 were retrospectively analyzed.According to the guidelines for Kidney Disease:Improving Global Outcomes(KDIGO),patients with AKI who started CRRT in stage 1 or 2 were included in the early treatment group,and those started CRRT in stage 3 were included in the late treatment group.The general clinical data,length of ICU stay,total length of hospital stay,28-day and 90-day mortality,CRRT duration,28-day and 90-day renal replacement therapy(RRT)disengagement rate,28-day and 90-day RRT dependence rate in the survival patients were compared between the two groups.Kaplan-Meier survival analysis was performed to assess the 90-day cumulative survival rate of patients with SA-AKI between two groups.Results A total of 244 SA-AKI patients were enrolled in this study,including 71 patients in the early treatment group and 173 patients in the late treatment group.There were no significant differences in age,gender composition,acute physiology and chronic health evaluationⅡ(APACHEⅡ),proportion of surgical patients,infection site and anticoagulation program between the two groups.The CRRT duration in the early group was significantly shorter than that in the late group[hours:26.0(12.0,49.0)vs.41.0(20.8,87.0),P<0.01],but there were no significant differences in the length of ICU stay[days:9.0(4.0,15.0)vs.10.0(4.5,18.0)],total length of hospital stay[days:17.0(10.0,30.0)vs.18.0(10.0,32.0)],28-day mortality(45.1%vs.48.0%),90-day mortality(46.4%vs.51.4%),28-day RRT disengagement rate(49.3%vs.45.1%)and 90-day RRT disengagement rate(52.1%vs.47.4%)between the early treatment group and late treatment group(all P>0.05).There were also no significant differences in 28-day RRT dependence rate[1

关 键 词：连续性肾脏替代治疗 脓毒症相关性急性肾损伤 预后 

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