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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
李青霖,胡新,毛智,齐霜,康红军,周飞虎.连续性肾脏替代治疗时机对脓毒症相关急性肾损伤患者28天预后的影响[J].中华老年多器官疾病杂志,2019,18(9):651~655
连续性肾脏替代治疗时机对脓毒症相关急性肾损伤患者28天预后的影响
Impact of timing of continuous renal replacement therapy on 28-day outcomes in patients with sepsis-associated acute kidney injury
投稿时间:2019-05-11  
DOI:10.11915/j.issn.1671-5403.2019.09.141
中文关键词:  脓毒症;急性肾损伤;连续性肾脏替代治疗;预后
英文关键词:sepsis; acute kidney injury; continuous renal replacement therapy; prognosis
基金项目:北京市科技计划课题(Z161100000116054);国家老年疾病临床医学研究中心课题(NCRCG-PLAGH-2017008)
作者单位E-mail
李青霖 解放军总医院第一医学中心重症医学科,北京 100853  
胡新 解放军总医院第一医学中心重症医学科,北京 100853  
毛智 解放军总医院第一医学中心重症医学科,北京 100853  
齐霜 解放军总医院第一医学中心重症医学科,北京 100853  
康红军 解放军总医院第一医学中心重症医学科,北京 100853  
周飞虎 解放军总医院第一医学中心重症医学科,北京 100853;解放军总医院 国家老年疾病临床医学研究中心,北京 100853 zhoufh301@126.com 
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中文摘要:
      目的 探讨重症监护病房(ICU)中脓毒症相关急性肾损伤(SI-AKI)患者临床特点及连续性肾脏替代治疗(CRRT)时机对28d预后的影响。方法 回顾性分析2017年6月至2018年12月解放军总医院第一医学中心重症医学科SI-AKI患者44例,根据AKI发生48h内是否行CRRT分为早期CRRT组29例和晚期CRRT组15例,比较2组患者各项生理功能指标及28d预后情况。应用SPSS 17.0统计软件对数据进行分析。Kaplan-Meier生存分析患者28d预后。结果 根据KDIGO分期标准,AKI 1期13.6%(6/44),2期18.2%(8/44),3期68.2%(30/44)。短暂性AKI占18.2%(8/44),持续性AKI占81.8%(36/44)。AKI发生28d时15例死亡。早期CRRT组相比晚期CRRT组患者糖尿病比例 (31.0%和6.7%, P=0.048) 高,CRRT时收缩压[(114±15)和(130±20)mmHg(1mmHg=0.133kPa), P=0.005]、平均动脉压[(82±11)和(91±18)mmHg, P=0.040]、血肌酐(197.0和418.9μmol/L, P=0.002)、尿素氮 (12.9和35.0mmol/L, P<0.001)、血钙 (1.9和2.0mmol/L; P=0.007)、血镁 (0.7和0.8mmol/L, P=0.013) 水平低,血红蛋白[(96±26)和(84±13)g/L, P=0.046]及血乳酸 (3.8和1.7mmol/L, P=0.009)水平高,AKI 3期患者比例(58.6%和86.7%, P=0.041)低。早期CRRT组患者28d病死率31%(9/29),晚期CRRT组患者28d病死率40%(6/15),2组比较差异无统计学意义 (P=0.575)。结论 早期CRRT没有明显改善SI-AKI患者28d病死率。
英文摘要:
      Objective To investigate the clinical characteristics of sepsis-associated acute kidney injury (SI-AKI) patients in intensive care unit (ICU) and the impact of timing of continuous renal replacement therapy (CRRT) on 28-day prognosis in them. Methods A retrospective analysis was made on 44 SI-AKI patients hospitalized in Department of Critical Care Medicine, the First Medical Center of Chinese PLA General Hospital from June 2017 to December 2018. According to whether CRRT was performed within 48 h after the occurrence of AKI, 29 patients were assigned into the early CRRT group, and the other 15 patients into the late CRRT group. Their physiological indicators and 28-day outcomes were compared between the 2 groups. SPSS statistics 17.0 was used to perform the statistical analysis. Kaplan-Meier survival analysis was employed to analyze the 28-day prognosis of the patients. Results According to the Kidney Disease:Improving Global Outcomes (KDIGO) Clinical Practice Guideline, there were 6(13.6%) patients at AKI stage 1,8(18.2%) at stage 2, and 30(68.2%) at stage 3. The patients having transient AKI accounted for 18.2%(8/44), and persistent AKI for 81.8%(36/44). Within 28 d after AKI occurrence, 15 cases died. The early CRRT group had a higher proportion of diabetes mellitus (31.0% vs 6.7%, P=0.048), and obviously lower levels of systolic blood pressure [(114±15) vs (130±15)mmHg,P=0.005] during the process of CRRT, mean arterial pressure [(82±11) vs (91±18)mmHg, P=0.040], serum creatinine (197.0 vs 418.9μmol/L, P=0.002,), urea nitrogen (12.9 vs 35.0mmol/L, P<0.001), serum calcium (1.9 vs 2.0mmol/L, P=0.007), serum magnesium (0.7 vs 0.8mmol/L, P=0.013), elevated serum levels of hemoglobin [(96±26) vs(84±13)g/L, P=0.041] and lactic acid (3.8 vs 1.7mmol/L, P=0.009), and lower proportion of those at AKI stage 3 (58.6% vs 86.7%, P=0.041), when compared with the late CRRT group. The 28-day mortality was 31% (9/29) in the early CRRT group, and 40%(6/15) in late CRRT group, and there was no significant difference between the 2 groups (P=0.575). Conclusion Early CRRT does not improve 28-day mortality in SI-AKI patients.
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