持续肾脏替代治疗对严重脓毒症不同程度急性肾损伤的疗效分析

摘要

目的：比较持续肾脏替代治疗对严重脓毒症不同程度急性肾损伤的临床疗效。方法选择2011年1月-2014年1月海南省人民医院重症医学科收治的严重脓毒症合并急性肾损伤（AKI）患者，按照患者接受持续性肾脏替代（CRRT）治疗时 AKI分期分为3组（A组为 AKI 1期，B组为 AKI 2期，C组为 AKI 3期），比较3组患者达多尿期（尿量＞400 mL/d）时间、肾功能恢复正常的比率、血肌酐恢复至基础水平的时间、CRRT 治疗时间、ICU的住院时间、ICU的治疗费用及28天生存率。结果 A组肾功能恢复率为100％（18/18），28天生存率为100％（18/18）；B组肾功能恢复率为91．30％（21/23），28天生存率为91．30％（21/23）；C组肾功能恢复率为61．54％（16/26），28天生存率为73．07％（19/26）。A、B组肾功能恢复率与C组比较差异有统计学意义（P ＜0．05）。A组与C组生存率比较差异有统计学意义（P ＜0．05），A组与B组及B组与C组生存率比较差异无统计学意义（P ＞0．05）。A、B组与C组肾功能恢复正常的患者达多尿期时间及血肌酐恢复至基础水平的时间差异有统计学意义（P ＜0．01），A、B组与C组CRRT治疗时间、ICU住院时间及ICU治疗费用差异均有统计学意义（P＜0．01）；A组与B组 ICU住院时间比较差异有统计学意义（P ＜0．05），CRRT治疗时间及 ICU治疗费用比较差异无统计学意义（P ＞0．05）。结论严重脓毒症合并 AKI，在早期（AKI 1期、2期）开始行 CRRT治疗，有利于肾功能早期恢复，并能显著改善肾功能，缩短CRRT治疗时间及 ICU的住院时间，减少 ICU的治疗花费。%Objective To compare the efficacy of continuous renal replacement therapy (CRRT ) for different degrees of acute kidney inj ury (AKI)caused followed by severe sepsis.Methods We retrospec-tively analyzed severe sepsis patients complicated with AKI admitted to ICU in our hospital from 2011 Jan-uary to 2014 January,patients were divided into 3 groups according to the which AKI stage they are in when receiving CRRT treatment (group A,B,C are respectively according to AKI stage 1,2,3),several indexes were compared such as polyuria period (urine volume>400 mL/days)time,ratio of normal renal function,the time serum creatinine returned to the basal level,CRRT time,length of stay and treatment costs in ICU,survival rate in 28 d.Results In group A,the recovery rate of renal function was 100%(18/18),survival rate was 100% (18/18);in group B,the recovery rate of renal function was 91.30%(21/23),survival rate was 91.30% (21/23),in group C,the recovery rate of renal function was 61.54%(16/26),survival rate was 73.70% (19/26),Survival rate between group A and C has statistical difference (P <0.05),while there were no such difference in neither between group A and B nor between group B and C (P>0.05).CRRT time,length of stay and treatment costs in ICU between group C and group A,B had statistical significance (P <0.05).In group A,the length of stay in ICU differed from group B (P <0.05),while CRRT time and treatment costs did not (P >0.05).Conclusion To treat severe sepsis com-plicated with AKI,to began CRRT treatment in the early stage (stage AKI-1,stage 2)is conducive to the early recovery of renal function,and can significantly improve renal function,shorten hospitalization time duration of CRRT treatment and reduce ICU treatment costs.