连续性肾脏替代治疗在儿童急性肾损伤的应用时机探讨  

The study on application time of continuous renal replacement therapy in children with acute kidney injury

作　　者：贺杰[1] 康霞艳 周雄[1] 蔡姿丽[1] 段蔚[1] 赵文姣[1] 张新萍[1] He Jie;Kang Xiayan;Zhou Xiong;Cai Zili;Duan Wei;Zhao Wenjiao;Zhang Xinping(Emergency Center,Hunan Children′s Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院急救中心,长沙410007

出　　处：《中国小儿急救医学》2021年第11期941-945,共5页Chinese Pediatric Emergency Medicine

基　　金：湖南省卫生计生委科研计划课题项目(A2016001)。

摘　　要：目的探讨连续性肾脏替代治疗(CRRT)在儿童急性肾损伤(AKI)的应用时机对预后的影响。方法前瞻性收集2015年3月至2020年2月在湖南省儿童医院重症医学科住院的AKI并行CRRT的患儿病历资料。根据AKI分期将符合标准的患儿分为早期组(AKI 1、2期)和延迟组(AKI 3期),记录两组患儿一般情况、启动CRRT时的指标及预后。结果(1)共39例患儿纳入研究,其中早期组23例,延迟组16例。两组患儿在月龄、性别、体重、机械通气比例等方面比较差异均无统计学意义(P均>0.05),早期组儿童危重病例评分高于延迟组(P=0.008);(2)两组患儿启动CRRT时血钾、碳酸氢根比较差异无统计学意义(P>0.05),早期组尿量高于延迟组(P<0.001),早期组血肌酐、尿素氮低于延迟组(P<0.05);(3)早期组患儿28 d存活率、28 d肾功能恢复比例显著高于延迟组(P<0.05),早期组CRRT持续时间、ICU住院时间、机械通气时间均短于延迟组(P<0.05)。结论当危重症患儿并发AKI时,在AKI 1、2期时早期启动CRRT,可以提高患儿28 d生存率,且能促进幸存者肾功能恢复。Objective To investigate the effect of the timing of continuous renal replacement therapy(CRRT)administration on the prognosis of acute kidney injury(AKI)in children.Methods The medical records of children with AKI who were admitted to the Intensive Care Unit of Hunan Children′s Hospital from March 2015 to February 2020 and underwent CRRT were prospectively analyzed.The children who met the criteria were divided into early group(defined as AKI 1 and 2)and delayed group(defined as AKI 3)according to AKI stage.The general conditions,indicators when CRRT was initiated,and prognosis of the children in two groups were recorded.Results(1)A total of 39 children were included in the study,including 23 in the early group and 16 in the delayed group.There were no significant differences in age,gender,body weight and proportion of mechanical ventilation between two groups(P>0.05).The score of critical cases in the early group was higher than that in the delayed group(P=0.008).(2)There were no significant differences in serum potassium and bicarbonate when CRRT was initiated between two groups(P>0.05).The urine output in the early group was higher than that in the delayed group(P>0.001).The serum creatinine and urea nitrogen in the early group were lower than those in the delayed group(P>0.05).(3)The 28-day survival rate and proportion of renal function recovery at 28 days in the early group were significantly higher than those in the delayed group(P>0.05).The duration of CRRT,ICU stay and duration of mechanical ventilation in the early group were shorter than those in the delayed group(P>0.05).Conclusion Early initiation of CRRT at AKI stage 1 and 2 can improve the 28-day survival rate and renal function recovery of survivors when critically ill children are complicated with AKI.

关 键 词：急性肾损伤 连续性肾脏替代治疗 应用时机 儿童 

分 类 号：R726.9[医药卫生—儿科]