较高剂量连续性肾脏替代治疗对脓毒症合并急性肾损伤患者疗效及安全性的影响OA
Impact of Higher-Dose Continuous Renal Replacement Therapy on Efficacy and Safety in Patients with Sepsis Complicated by Acute Kidney Injury
目的 研究较高剂量连续性肾脏替代治疗(CRRT)对脓毒症合并急性肾损伤(AKI)患者疗效以及安全性的影响.方法 选择2021年9月至2024年10月深圳市盐田区人民医院ICU收治的60例脓毒症合并AKI患者作为研究对象,按随机数表法划分为观察组与对照组各30例.两组均接受常规治疗,对照组给予20～25 mL·kg-1·h-1标准剂量CRRT,观察组给予30～35 mL.kg-1·h-1较高剂量CRRT.比较两组的临床疗效、肾功能、血流动力学、炎性因子水平以及不良事件发生情况.结果 观察组的尿量恢复时间和ICU住院时间均明显短于对照组(P＜0.05).两组的继续肾脏替代治疗比例、28d病死率、机械通气时间、序贯器官衰竭评估(SOFA)评分及急性生理学和慢性健康评估Ⅱ(APACHE Ⅱ)评分比较均无显著差异(P＞0.05).两组治疗后的血肌酐(Scr)、血尿素氮(BUN)、降钙素原(PCT)、C反应蛋白(CRP)水平均较治疗前明显降低(P＜0.05),但组间比较差异无统计学意义(P＞0.05).两组的血管活性药物使用量、平均动脉压(MAP)比较无显著差异(P＞0.05).两组的不良事件发生率比较无显著差异(P＞0.05).结论 30～35 mL·kg-1·h-1较高剂量CRRT可显著缩短脓毒症合并AKI患者的肾功能恢复时间和ICU住院时间,且未显著增加严重不良事件发生率.
Objective To investigate the impact of higher-dose continuous renal replacement therapy(CRRT)on the efficacy and safety in patients with sepsis complicated by acute kidney injury(AKI).Methods A total of 60 patients with sepsis complicated by AKI admitted to the ICU of Yantian District People's Hospital of Shenzhen from September 2021 to October 2024 were enrolled and divided into the observation group and the control group using the random number table,with 30 cases in each group.Both groups received conventional treatment.The control group was given standard-dose CRRT at 20～25 mL·kg-1·h-1,while the observation group was given higher-dose CRRT at 30～35 mL·kg-1·h-1.The clinical efficacy,renal function,hemodynamics,inflammatory factor levels and incidence of adverse events were compared between the two groups.Results The time to urine output recovery and ICU length of stay in the observation group were significantly shorter than those in the control group(P＜0.05).There was no statistically significant difference in the proportion of ongoing renal replacement therapy,28-day mortality rate,duration of mechanical ventilation,Sequential Organ Failure Assessment(SOFA)score and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score between the two groups(P＞0.05).After treatment,the levels of serum creatinine(Scr),blood urea nitrogen(BUN),procalcitonin(PCT)and C-reactive protein(CRP)in both groups significantly decreased compared with pre-treatment(P＜0.05),but there was no statistically significant difference between the two groups(P＞0.05).There was no significant difference in the use of vasoactive drugs and mean arterial pressure(MAP)between the two groups(P＞0.05).There was no statistically significant difference in the incidence of adverse events between the two groups(P＞0.05).Conclusions Higher-dose CRRT at 30～35 mL·kg-1·h-1 can significantly shorten the time to renal function recovery and ICU length of stay in patients with sepsis complicated by AKI,without significantly increasing the incidence of serious adverse events.
荆璐;刘晅;黄建鑫
深圳市盐田区人民医院 呼吸与危重症医学科,广东 深圳 518081深圳市盐田区人民医院 急诊科,广东 深圳 518081深圳市盐田区人民医院 EICU,广东 深圳 518081
医药卫生
较高剂量连续性肾脏替代治疗脓毒症急性肾损伤疗效安全性
Higher-doseContinuous renal replacement therapySepsisAcute kidney injuryEfficacySafety
《临床医学工程》 2026 (7)
795-799,5
深圳市盐田区医疗卫生科技创新项目(项目编号:YTWS20200206)
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