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目的探讨感染性急性肾损伤(Septic AKI)患者应用连续性肾脏替代治疗(CRRT)的最佳时机。方法以2009年3月至2012年12月大连医科大学附属大连市中心医院外科ICU住院的资料完整的118例感染性AKI患者为研究对象。将其分为2期CRRT组及2期对照组(常规治疗);3期早期CRRT组及3期晚期CRRT组。比较各组患者治疗前及治疗后48 h的血清肌酐、血尿素氮、血清钾、平均动脉压、氧合指数、血乳酸值、尿量、APACHEⅡ评分、SOFA评分;机械通气时间及住ICU时间;28 d及90 d的病死率。结果经过48 h的治疗,3个CRRT组患者的血清肌酐、血尿素氮及血清钾均明显好转,3期早期CRRT组与晚期CRRT组相比下降明显;2期对照组、2期CRRT组及3期早期CRRT组患者的平均动脉压、氧合指数、血清乳酸、尿量、APACHEⅡ评分及SOFA评分均明显好转;3期早期CRRT组与晚期CRRT组相比,平均动脉压、氧合指数、血清乳酸、尿量明显好转;3期早期CRRT组患者的机械通气时间及住ICU时间均明显短于3期晚期CRRT组患者;3期晚期CRRT组的28 d及90 d病死率均明显高于3期早期CRRT组。结论 CRRT是治疗Septic AKI的有效措施;关于Septic AKI患者进行CRRT治疗时机的选择上,对于2期患者,CRRT治疗对患者的预后影响不大;对于3期患者,需尽早予以CRRT治疗。
Objective To investigate the optimal timing of continuous renal replacement therapy (CRRT) in patients with septic AKI. Methods A total of 118 cases of infectious AKI patients who were hospitalized in Department of Surgery, Dalian Central Hospital Affiliated to Dalian Medical University from March 2009 to December 2012 were selected as the study subjects. Divided into 2 CRRT group and 2 control group (conventional treatment); 3 early CRRT group and 3 late CRRT group. Serum creatinine, blood urea nitrogen, serum potassium, mean arterial pressure, oxygenation index, blood lactate, urine output, APACHEⅡscore and SOFA score were compared between before and 48h after treatment in each group. The duration of mechanical ventilation and ICU stay ; 28 d and 90 d mortality. Results After 48 hours of treatment, serum creatinine, blood urea nitrogen and serum potassium in 3 CRRT patients were significantly improved. The CRRT group in early stage 3 showed a significant decrease compared with CRRT group in late stage 3, CRRT group 2 and CRRT stage 2 Mean arterial pressure, oxygenation index, serum lactate, urine output, APACHEⅡscore and SOFA score were significantly improved in patients with early phase 3 CRRT. Compared with late CRRT group, mean arterial pressure, oxygenation index, Serum lactate and urine volume were significantly improved. The duration of mechanical ventilation and ICU stay in stage 3 early CRRT patients were significantly shorter than those in stage 3 late CRRT patients. The mortality rates at 28 d and 90 d in stage 3 advanced CRRT patients were significantly higher than those in stage 3 CRRT patients 3 early CRRT group. Conclusions CRRT is an effective measure to treat Septic AKI. Regarding the timing of CRRT treatment in Septic AKI patients, CRRT treatment has little effect on the prognosis of patients in stage 2 patients. CRRT treatment is required in stage 3 patients as soon as possible.