不同时机连续性肾脏替代治疗用于感染性休克合并急性肾损伤患者的效果  

Effects of continuous renal replacement therapy at different times on patients with septic shock complicated with acute kidney injury

作　　者：顿少志 刘畅[1] 王宝玉[1] DUN Shaozhi;LIU Chang;WANG Baoyu(Department of Emergency Medicine of Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000 Henan,China)

机构地区：[1]郑州大学附属郑州市中心医院急诊医学科,河南郑州450000

出　　处：《中国民康医学》2023年第18期53-55,共3页Medical Journal of Chinese People’s Health

摘　　要：目的:观察不同时机连续性肾脏替代治疗(CRRT)用于感染性休克合并急性肾损伤(AKI)患者的效果。方法:回顾性分析2020年9月至2022年9月该院收治的87例感染性休克合并AKI患者的临床资料,按照CRRT时机不同将其分为对照组43例与观察组44例。对照组于确诊48 h后行CRRT,观察组于确诊12 h内行CRRT,比较两组治疗14 d后生存率、肾功能指标[血尿素氮(BUN)、血肌酐(Scr)、β2微球蛋白(β2-MG)及胱抑素C(Cys C)]水平、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、血清脑钠肽(BNP)水平和血清炎性因子[白细胞介素(IL)-10、IL-6、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)]水平。结果:治疗14 d后,观察组生存率为90.91%(40/44),明显高于对照组的74.42%(32/43),差异有统计学意义(P<0.05);治疗14 d后,两组存活患者血清BUN、Scr、β2-MG、Cys C、BNP、IL-10、IL-6、TNF-α和PCT水平及APACHEⅡ评分低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。结论:于确诊12 h内应用CRRT治疗感染性休克合并AKI患者可提高生存率,降低血清肾功能指标、BNP、炎性因子水平和APACHEⅡ评分,效果优于确诊48 h后行CRRT。Objective:To observe effects of continuous renal replacement therapy(CRRT)at different times on patients with septic shock complicated with acute kidney injury(AKI).Methods:The clinical data of 87 patients with septic shock complicated with AKI admitted to the hospital from September 2020 to September 2022 were retrospectively analyzed.According to different CRRT timing,they were divided into control group(43 cases)and observation group(44 cases).The control group received CRRT 48 h after diagnosis,while the observation group received CRRT within 12 h after diagnosis.The survival rate,the serum renal function index levels[blood urea nitrogen(BUN),serum creatinine(Scr),β2-microglobulin(β2-MG)and cystatin C(Cys C)],the acute physiology and chronic health evaluation II(APACHE II)score,the serum brain natriuretic peptide(BNP)level,and the serum inflammatory mediator levels[interleukin(IL)-10,IL-6,tumor necrosis factor-α(TNF-α)and procalcitonin(PCT)]were compared between the two groups after 14 days of treatment.Results:After 14 days of treatment,the survival rate of the observation group was 90.91%(40/44),which was significantly higher than 74.42%(32/43)of the control group,and the difference was statistically significant(P<0.05).After 14 days of treatment,the levels of serum BUN,Scr,β2-MG,Cys C,BNP,IL-10,IL-6,TNF-αand PCT and APACHE II score in the two groups were lower than those before the treatment,those in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusions:CRRT within 12 hours after diagnosis can improve the survival rate of the patients with septic shock complicated with AKI,and reduce the levels of serum renal function indexes,BNP,serum inflammatory mediators and the APACHE II scores.Moreover,it is superior to CRRT 48 hours after diagnosis.

关 键 词：连续性肾脏替代治疗 感染性休克 急性肾损伤 肾功能 炎性因子 脑钠肽 

分 类 号：R631[医药卫生—外科学]