早期启动CRRT对老年脓毒症急性肾损伤患者肾功能、全身炎症反应及短期预后的影响

doi:10.3969/j.issn.1001-8131.2025.03.012

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摘要目的探究早期启动连续性肾脏替代治疗（CRRT）对老年脓毒症急性肾损伤患者肾功能、全身炎症反应及短期预后的影响。方法回顾性选取67例老年脓毒症合并急性肾损伤患者作为研究对象,根据CRRT启动时间分为早期组（n=35）和晚期组（n=32）,早期组在确诊患者合并AKI后12h内启动CRRT,晚期组延迟至48h开始CRRT治疗。对所有患者数据进行倾向性匹配评分,采用倾向评分法来平衡组间基线特征和校正潜在混杂因素,共有29对患者基线差异无统计学意义（P>0.05）。比较两组患者治疗效果、肾功能、全身炎症反应、短期预后情况、不良反应发生情况。结果治疗后,早期组患者序贯器官衰竭（SOFA）评分、急性生理与慢性健康（APACHE Ⅱ）评分低于晚期组（P<0.05）。治疗后,早期组患者血肌酐（SCr）、尿素氮（BUN）、超敏C反应蛋白（hs-CRP）、肿瘤坏死因子-α（TNF-α）水平低于晚期组（P<0.05）,而两组患者治疗后的尿蛋白、白细胞介素-6（IL-6）水平相近（P>0.05）。早期组患者28 d病死率、ICU住院时间均低于晚期组（P<0.05）,而两组患者90 d病死率相近（P>0.05）。两组不良反应率相近（χ²=0.744,P>0.05）。结论相较于晚期启动CRRT,早期启动更能改善老年脓毒症急性肾损伤患者病情及肾功能,缓解患者全身炎症反应,改善短期预后,且具有安全性。

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关键词 ：脓毒症, 急性肾损伤, 持续性肾脏替代治疗, 肾功能, 全身炎症

Abstract：Objective To explore the effect of early initiation of continuous renal replacement therapy(CRRT)on renal function,systemic inflammatory response and short-term prognosis in elderly patients with acute kidney injury with sepsis. Methods Retrospectively selected 67 elderly patients with sepsis and acute kidney injury admitted to the Emergency intensive care department,early group(n=35)and late group(n=32)in the early group initiated CRRT within 12 hours after confirmed patients with AKI,and CRRT treatment was delayed to 48 hours in the late group.After propensity matching scores for all patient data,using propensity scoring to balance baseline characteristics between groups and adjusting for potential confounding factors,a total of 29 patients with no statistically significant difference in baseline.The treatment effect,renal function,systemic inflammatory response,short-term prognosis,and adverse reactions were compared between the two groups. Results After treatment,the sequential organ failure(SOFA)score,acute physiology and chronic health(APACHE Ⅱ)scores were lower than those in the advanced group(P<0.05).After treatment,the blood creatinine(SCr),urea nitrogen(BUN),hypersensitive C-responsive protein(hs-CRP)(TNF-α)were lower than in the advanced group(P<0.05),while the levels of urinary protein,interleukin-6(IL-6)were similar(P>0.05).The 28 d mortality and ICU stay in the early group were lower than the late group(P<0.05),while the 90 d mortality in the two groups was similar(P>0.05).The adverse reaction rate was similar in the two groups(χ²=0.744,P>0.05). Conclusion Compared with late CRRT,early initiation can improve the condition and renal function of elderly patients with acute kidney injury,relieve systemic inflammatory response,improve short-term prognosis,and have safety.

Key words： sepsis acute kidney injury persistent renal replacement therapy renal function systemic inflammation

收稿日期: 2025-02-18

PACS:

R692.3

引用本文:

刘彦群, 孙立东, 于吉芬. 早期启动CRRT对老年脓毒症急性肾损伤患者肾功能、全身炎症反应及短期预后的影响[J]. 哈尔滨医药, 2025, 45(3): 43-46.
Liu Yanqun, Sun Lidong, Yu Jifen. Effect of Early Initiation of CRRT on Renal Function,Systemic Inflammatory Response and Short-term Prognosis in Elderly Patients with Septic Acute Kidney Injury. journal1, 2025, 45(3): 43-46.

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http://www.hrbyybjb.org.cn/CN/10.3969/j.issn.1001-8131.2025.03.012 或 http://www.hrbyybjb.org.cn/CN/Y2025/V45/I3/43

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