连续性肾脏替代治疗对ICU急性肾损伤患者能量代谢与热量平衡的影响  

Clinical study of CRRT effect on energy metabolism and thermal balance in ICU patients with acute kidney injury

作　　者：高建平[1] 王勇刚[1] 李丛丛 汤丽萍 金信浩 潘孔寒[1] Gao Jianping;Wang Yonggang;Li CongCong;Tang Liping;Jin Xinhao;Pan Konghan(Critical Care Department&Provincial Key Laboratory of Precise Diagnosis and Treatment of Abdominal Infection,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院重症医学科,浙江省腹腔感染精准诊疗重点实验室,杭州310016

出　　处：《中华急诊医学杂志》2025年第2期233-240,共8页Chinese Journal of Emergency Medicine

基　　金：浙江省医药卫生科技计划-临床研究应用项目(2022KY824)。

摘　　要：目的探索连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对ICU急性肾损伤(acute kidney injury,AKI)患者能量代谢与热量平衡的影响。方法本研究为前瞻观察性研究,纳入2020年5月至2023年12月在浙江大学医学院附属邵逸夫医院ICU内接受CRRT治疗的AKI患者,记录患者临床一般特征、基础合并症、体温、病情严重度评分、CRRT治疗时间及滤器寿命等,定时测定血液和超滤液中葡萄糖、乳酸浓度,局部枸橼酸抗凝时测定超滤液中枸橼酸的浓度,依据不同的抗凝模式及是否是糖尿病、休克患者进行亚组分析,计算每日CRRT所引起的葡萄糖、乳酸、枸橼酸与体温变化而对应的热能变化。结果本研究共纳入420例行CRRT的AKI患者。当血乳酸在14~18 mmol/L时,每日对应约有200~250 kcal能量的丢失;当血乳酸在6.5~11.5 mmol/L时,每日对应能量的丢失约为100~150 kcal。首日行CRRT的糖尿病患者与休克患者都存在轻度的葡萄糖丢失,非糖尿病与非休克患者则存在轻度的葡萄糖增加。48 h后随着血糖的控制与达标,行CRRT的患者平均每日增加的葡萄糖对应的热卡约为100~130 kcal。行局部枸橼酸抗凝的CRRT患者平均每日枸橼酸进入机体对应热卡约为330 kcal。体温每降低1℃,因CRRT管路散热引起的日平均热能丢失约为200 kcal。结论在对ICU内CRRT支持的AKI患者行营养评估与处方时,需要充分考虑CRRT对患者能量代谢与热量平衡的影响,包括乳酸的清除、血糖的平衡、枸橼酸的摄入及体温的降低,同时要考虑到疾病类型与所处的阶段以及个体间的差异,以达到营养的个体化评估与精准实施。Objective To investigate the effect of continuous renal replacement therapy(CRRT)on energy metabolism and thermal balance in ICU patients with acute kidney injury(AKI).Methods This study was a prospective observational study,which included AKI patients who underwent CRRT in ICU of the Sir Run Run Shaw Hospital,Zhejiang University School of Medicine from May 2020 to December 2023.The patients'general clinical characteristics,comorbidities,body temperature,disease severity score,CRRT treatment time and filter lifespan were recorded.The concentrations of glucose and lactate in blood and ultrafiltrate,and the citrate level in the ultrafiltrate when regional citrate anticoagulation adopted were analyzed regularly.Subgroup analysis was carried out according to different anticoagulation modes and whether the patients with diabetes or shock.The changes of energy metabolism and thermal balance corresponding to the changes in glucose,lactate,citrate and body temperature induced by CRRT were calculated daily.Results This study included 420 AKI patients undergoing CRRT.When the blood lactate was between 14-18 mmol/L,there was a loss of approximately 200-250 kcal of energy per day,while the blood lactate was between 6.5-11.5 mmol/L,the daily corresponding energy loss was about 100-150 kcal.During CRRT on the first day,the patients with diabetes or shock had a mild decrease of blood glucose,while patients without diabetes and shock had mild increase of blood glucose.When the target of blood glucose was gradually achieved,the mean daily increase of energy corresponding to blood glucose intake was about 100-130 kcal in patients undergoing CRRT.The mean daily increase of energy corresponding to citrate intake was approximately 330 kcal,when the patient was undertaken by CRRT with regional citrate anticoagulation.For every 1℃decrease in body temperature,the mean daily heat loss caused by extracorporeal thermal radiation during CRRT was about 200 kcal.Conclusions When conducting nutritional assessment and prescription for AKI pat

关 键 词：急性肾损伤 连续性肾脏替代治疗 能量代谢 体温变化 营养评估 葡萄糖 枸橼酸 乳酸 

分 类 号：R692.5[医药卫生—泌尿科学]