不同CRRT治疗时机对脓毒症合并急性肾功能不全患者疗效及预后的影响

目的:探讨不同持续性肾脏替代治疗(CRRT)治疗时机对脓毒症合并急性肾功能不全患者的临床疗效及预后的影响。方法:将我院ICU收治的60例脓毒症合并急性肾功能不全患者,按照CRRT治疗时机分为早期组(1-2期,n=30)和晚期组(3期,n=30)。比较两组患者治疗前后不同时点平均动脉压(MAP)、白细胞(WBC)计数、血红蛋白(HB)、血小板(PLT)计数、急性生理学与慢性健康状况(APACHE)Ⅱ评分等临床资料的变化,机械通气时间,肾功能恢复率及28 d病死率等。结果:与早期组比较,晚期组治疗后WBC计数明显升高(P0.05)。治疗后12 h、24 h、72 h,早期组ACHEⅡ评分较晚期组显著降低(P0.05)。与晚期组比较,早期组机械通气时间显著缩短,肾功能恢复明显升高,28d内病死率也明显降低(P0.05)。结论:脓毒症合并急性肾功能不全患者应早期启动CRRT治疗,最佳介入时间是KDIGO-AKI 3期之前,有助于改善患者预后。

Effect of Continuous Renal Replacement Therapy Started at Different Time on the Sepsis Patients with Acute Renal Insufficiency

ABSTRACT Objective: To explore the effect of continuous renal replacement therapy (CRRT) started at different time in sepsis pa- tients with acute renal insufficiency. Methods: 60 critical patients who were admitted in the ICU of our hospital were divided into two groups including early group(stage 1-2, n=30) and late group(stage 3, n=30). The clinical data such as mean arterial pressure (MAP), white blood cells (WBC) count, hemoglobin (HB), platelet (PLT) count were compared before treatment, and change of APACHE II scores at different time, the duration of mechanical ventilation, and the mortality within 28days were analyzed. Results: Before treatment, there was no significant difference in the levels of MAP, HB, PLT count and lactic acid between two groups (P>0.05). Compared with early group, the WBC count in late group was obviously increased (P<0.05). The APACHE II score in early group were significantly lower than those in late group at 12 h, 24 h and 72h after treatment(P<0.05). Compared with early group, the duration of mechanical ventilation in late group were shortened, renal function recovery rate were increased, and the mortality within 28 days were reduced (P<0.05). Conclusion: The CRRT for sepsis patients with acute renal insufficiency should be started early, the optimal timing of initiating CRRT may predate to KDIGO-AKI 3 phase, which can contribute to improve the prognosis.