脓毒症急性肾损伤连续性肾脏替代治疗中尿量变化对预后的影响  

Effect of changes in urine volume on prognosis of patients with sepsis and acute kidney injury after continuous renal replacement therapy

作　　者：张族勤 ZHANG Zuqin(Department of Critical Care Medicine,Sanming First Hospital Affiliated to Fujian Medical University,Fujian,Sanming,365000,China)

机构地区：[1]福建医科大学附属三明第一医院重症医学科,福建三明365000

出　　处：《中国医药科学》2021年第12期178-182,共5页China Medicine And Pharmacy

摘　　要：目的探讨脓毒症(Sepsis)急性肾损伤(AKI)连续性肾脏替代治疗(CRRT)中尿量变化对预后的影响。方法收集2018年1月至2019年12月福建医科大学附属三明第一医院重症医学科(ICU)收治的79例脓毒症伴少尿型急性肾损伤2期(AKI 2期)患者作为研究对象,所有患者入院后接受常规治疗和CRRT治疗,治疗过程中精确记录每日尿量,根据少尿期标准,即每日尿量少于800 ml,将少尿期持续时间≤7 d患者分为Ⅰ组(n=39),将少尿期持续时间>7 d患者分为Ⅱ组(n=40)。观察两组患者肾功能恢复情况,比较两组患者30 d、60 d、90 d死亡率。对少尿期持续时间≤7 d与少尿期持续时间>7 d之间进行生存分析。结果Ⅰ组69.23%(27/39)患者肾功能完全恢复,明显高于Ⅱ组,差异有统计学意义(P<0.05),同时Ⅰ组50%(20/40)患者肾功能未恢复,明显高于Ⅱ组(P<0.05),肾功能部分恢复比例两组间比较,差异无统计学意义(P>0.05);生存分析表明Ⅰ组与Ⅱ组之间差异有统计学意义(P<0.05)。结论脓毒症急性肾损伤CRRT治疗中少尿期持续时间>7天与不利的肾功能恢复及预后相关,观察少尿期持续时间可以帮助临床医生评估预后。Objective To investigate the effect of changes in urine volume on the prognosis of patients with sepsis and acute kidney injury(AKI)after continuous renal replacement therapy(CRRT).Methods A total of 79 patients with sepsis and oliguria AKI at stageⅡ(AKI stageⅡ)admitted to ICU of Sanming First Hospital Affiliated to Fujian Medical University from January 2018 to December 2019 were collected as research objects.All patients received conventional treatment and CRRT after admission.The daily urine volume(DUV)during the treatment was accurately recorded.According to the standard of oliguria period(DUV<800 ml),the patients were divided into groupⅠ(39 cases,the duration of oliguria≤7 days)and groupⅡ(40 cases,the duration of oliguria>7 days).The recovery of renal function in the two groups was observed,and 30-day,60-day and 90-day mortality rates were compared between the two groups.Survival analysis was carried out on groupⅠand groupⅡ.Results In groupⅠ,69.23%(27/39)of patients had complete recovery of renal function,which was significantly higher than that in groupⅡ(P<0.05).Moreover,50%(20/40)of patients in groupⅡhad their renal function unrecovered,which was significantly higher than that in groupⅠ(P<0.05).There was no significant difference in the proportion of patients with partial recovery of renal function between the two groups(P>0.05).Survival analysis showed that there was a significant difference between groupⅠand groupⅡ(P<0.05).Conclusion The duration of oliguria over 7 days is related to adverse recovery of renal function and prognosis of patients with sepsis and AKI treated with CRRT.To monitor the duration of oliguria can help clinicians evaluate the prognosis.

关 键 词：脓毒症 急性肾损伤 CRRT 尿量 预后 

分 类 号：R459.7[医药卫生—急诊医学]