陈锦源 姚慧文 林福筹 林锦锋 梁启光 周瑞辉

[摘要]目的 探討连续性肾脏替代治疗（CRRT）不同应用时机在脓毒症伴急性肾损伤（AKI）患者中的效果。方法 选取2018年4月～2019年8月广东省江门市新会区人民医院重症医学科收治的84例行CRRT的脓毒症伴AKI 2期/3期患者作为研究对象进行回顾性分析。按2012年KDIGO指南的AKI分期，将脓毒症伴AKI 2期进行CRRT患者作为早期组（41例），脓毒症伴AKI 3期进行CRRT患者作为晚期组（43例）。比较两组患者CRRT前及CRRT 72 h后的炎症介质[白介素-10（IL-10）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）及降钙素原（PCT）]水平，比较两组患者的住院时间、总住院时间、90 d病死率、住院病死率。结果 早期组CRRT 72 h后的PCT、IL-6、IL-10及TNF-α水平低于晚期组，差异有统计学意义（P<0.05）;早期组患者的ICU住院时间及总住院时间均短于晚期组，差异有统计学意义（P<0.05）;早期组患者的90 d病死率及住院病死率均低于晚期组，差异有统计学意义（P<0.05）。结论 CRRT不同治疗时机在脓毒症伴AKI患者中的应用效果差异较大，与脓毒症伴AKI 3期行CRRT比较，脓毒症伴AKI 2期行CRRT可有效减轻炎症反应，缩短ICU住院时间及总住院时间，降低90 d病死率和住院病死率。

[关键词]连续性肾脏替代治疗;应用时机;脓毒症;急性肾损伤;疗效

[中图分类号] R692.5          [文献标识码] A          [文章编号] 1674-4721（2020）7（b）-0051-04

Effect of different application timings of continuous renal replacement therapy in patients with sepsis and acute kidney injury

CHEN Jin-yuan   YAO Hui-wen   LIN Fu-chou   LIN Jin-feng   LIANG Qi-guang   ZHOU Rui-hui

Department of Intensive Care Unit， People′s Hospital of Xinhui District in Jiangmen City， Xinhui Hospital Affiliated to Southern Medical University， Guangdong Province， Jiangmen   529100， China

[Abstract] Objective To explore the effect of different application timings of continuous renal replacement therapy （CRRT） in patients with sepsis and acute kidney injury. Methods A retrospective analysis was conducted on 84 patients receved CRRT with sepsis and AKI stage 2/3 admitted to the Department of Intensive Care Unit， People′s Hospital of Xinhui District in Jiangmen City， Guangdong Province from April 2018 to August 2019. According to the AKI staging in 2012 KDIGO guidelines， patients with sepsis and AKI stage 2 for CRRT were selected as the early group （41 cases）， and patients with sepsis and AKI stage 3 for CRRT were selected as the late group （43 cases）. The levels of inflammatory mediators （interleukin-10 [IL-10]， interleukin-6 [IL-6]， tumor necrosis factor-α [TNF-α] and procalcitonin [PCT]） before and after CRRT for 72 h were compared between the two groups. The length of hospital stay， total length of hospital stay， fatality rate at 90 days and fatality rate in hospital were compared between the two groups. Results The PCT， IL-6， IL-10 and TNF-α levels after CRRT for 72 h in the early group were lower than those in the late group， and the differences were statistically significant （P<0.05）. The length of ICU stay and total length of hospital stay in the early group were shorter than those in the late group， and the differences were statistically significant （P<0.05）. The fatality rate at 90 days and fatality rate in hospital in the early group were lower than those in the late group， with statistically significant differences （P<0.05）. Conclusion The application effect of different application timings of CRRT in patients with sepsis and acute kidney injury are varies greatly. Compared with sepsis and AKI stage 3 for CRRT， sepsis and AKI stage 2 for CRRT could effectively reduce inflammatory response， shorten the length of ICU stay and total length of hospital stay， and reduce the fatality rate at 90 days and fatality rate.

[Key words] Continuous renal replacement therapy; Application timings; Sepsis; Acute renal injury; Efficacy

[基金项目]广东省江门市卫生计生局科研立项项目（18A 009）

[作者简介]陈锦源（1985-），广东江门人，本科，副主任医师，研究方向：重症疾病的治疗

重症感染或脓毒症导致患者发生急性肾损伤（acute kidney injury，AKI）的情况逐年增多，2015年《柳叶刀》[1]发表的一项关于全球范围内AKI的流行病学调查显示，每年约1300万人发生AKI，其中发展中国家的患者占85%，约170万人死于AKI及其并发症。2017年《中华重症医学电子杂志》[2]发表中国AKI的流行病学资料调查显示，中国住院患者的AKI发生率为0.99%～11.60%。ICU患者AKI的发病率及病死率高于普通病房，远期预后差。ICU中发生AKI是患者死亡的独立危险因素，可使病死率增加50%以上[3]。脓毒症导致的AKI 1、2、3期患者分别对应了AKI的危险、损伤及衰竭分级。……