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目的探讨连续性肾脏替代治疗(CRRT)治疗感染性急性肾损伤的最佳时机,以期为急性肾损伤患者的规范治疗提供一定的临床数据。方法选取2013年1月—2015年12月杭州师范大学附属医院ICU住院且资料齐全的接受CRRT治疗的感染性急性肾损伤患者120例,按照急性肾功能衰竭的改善全球肾脏病预后组织(KDIGO)诊断标准分为Ⅰ、Ⅱ、Ⅲ期组。比较各组的住院病死率和肾功能恢复率,并比较各组患者治疗前及CRRT治疗后48 h的APACHEⅡ评分、SOFA评分、氧合指数(OI)、平均动脉压(MAP)、血清肌酐(Scr)、血尿素氮(BUN)、需要血管活性药物例数。结果 3组患者病死率和肾功能完全恢复率相比差异具有统计学意义(χ~2=10.394、22.200,均P<0.05)。Ⅲ期病死率显著高于Ⅰ期和Ⅱ期,肾功能完全恢复率显著性低于Ⅰ期和Ⅱ期,差异均具有统计学意义(χ~2≥6.545,均P<0.017)。Ⅰ期和Ⅱ期组患者治疗后血清肌酐、血尿素氮、氧合指数、平均动脉压、APACHEⅡ评分、SOFA评分均较治疗前显著改善(t≥4.09,均P<0.05);Ⅲ期组患者治疗前后APACHEⅡ评分、SOFA评分、OI、MAP、Scr、BUN、需要血管活性药物例数指标无显著性变化(t≤1.61,均P>0.05)。结论 CRRT治疗可明显改善KDIGO标准分期Ⅰ、Ⅱ期患者的预后,而对Ⅲ期患者预后影响不大,故临床上必须重视CRRT时机的选择。
Objective To investigate the best timing of continuous renal replacement therapy (CRRT) for the treatment of acute kidney injury in patients with acute renal injury in order to provide some clinical data. Methods From January 2013 to December 2015, 120 patients with infectious acute kidney injury (CRDT) who were admitted to ICU and hospitalized in ICU of Hangzhou Normal University were enrolled in this study. According to the criteria of KDIGO (Acute Renal Failure) Diagnostic criteria are divided into Ⅰ, Ⅱ, Ⅲ group. The hospital mortality and renal function recovery rate of each group were compared, and APACHEⅡscore, SOFA score, oxygenation index (OI), mean arterial pressure (MAP), serum creatinine Scr), blood urea nitrogen (BUN), the number of vasoactive drugs required. Results There was significant difference between the three groups in mortality and complete recovery of renal function (χ ~ 2 = 10.394,22.200, all P <0.05). The mortality of stage Ⅲ was significantly higher than that of stage Ⅰ and Ⅱ. The complete recovery of renal function was significantly lower than that of stage Ⅰ and Ⅱ (χ ~ 2≥6.545, both P <0.017). Serum creatinine, blood urea nitrogen, oxygenation index, mean arterial pressure, APACHEⅡscore and SOFA score were significantly improved in patients in stage Ⅰ and group Ⅱ after treatment (t ≥ 4.09, all P <0.05). Patients in stage Ⅲ Before and after treatment APACHE Ⅱ score, SOFA score, OI, MAP, Scr, BUN, the number of vasoactive drugs required no significant change in the number of indicators (t ≤ 1.61, all P> 0.05). Conclusion CRRT can significantly improve the prognosis of stage I and II patients with KDIGO standard stage, but it has little effect on the prognosis of stage III patients. Therefore, the clinical choice of CRRT timing must be emphasized.