摘要
目的探讨重症感染并发急性肾损伤进行血液净化的时机选择。方法选择2016年1月—2018年8月该院收治的重症感染并发急性肾损伤患者150例作为研究对象,按AKI 1、2、3期分为3组,每组50例,分别在1、2、3期进行连续性血液净化(CRRT)治疗。观察指标3组治疗后14、28 d生存率;并对CRRT治疗前中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、B型尿钠肽(BNP)、急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分情况。结果甲组治疗后14、28 d生存率94.0%、82.0%高于乙、丙组(84.0%、66.0%)和(66.0%、50.0%)(P<0.05);回归分析结果显示NGAL、BNP、APACHEⅡ评分是重症感染并发急性肾损伤患者预后的独立影响因素;作为CRRT主要介入指征的AKI临床分期,与首次治疗前NGAL、BNP、APACHEⅡ正相关(r=0.623、0.462、0.369,P<0.01)。结论对于重症感染并发急性肾损伤患者,早期行CRRT治疗可有效改善患者预后,治疗时机除肾功能外,应参考NGAL、BNP、APACHEⅡ评分。
Objective To explore the timing of blood purification for severe infection complicated with acute kidney injury.Methods 150 patients with severe infection complicated with acute kidney injury admitted to the hospital from January 2016 to August 2018 were convenient selected as the research objects. They were divided into 3 groups according to AKI 1,2 and 3, with 50 cases in each group, continuous blood purification(CRRT) treatment was carried out in phases 1, 2 and 3.Observation indicators: survival rates at 14 and 28 d after treatment in the three groups;and neutrophil gelatinase-associated lipocalin(NGAL), B-type natriuretic peptide(BNP), acute physiology and chronic health Ⅱ(APACHE Ⅱ) scoring situation before CRRT treatment. Results 14 and 28 d after treatment, the survival rate of group A was 94.0%, 82.0%higher than that of groups B and C(84.0%, 66.0) and(66.0%, 50.0%)(P<0.05);Regression analysis results showed that NGAL, BNP, and APACHE Ⅱ scores were independent factors affecting the prognosis of patients with severe infection complicated by acute kidney injury;AKI clinical staging, which was the main interventional indication for CRRT, was positively correlated with NGAL, BNP and APACHE Ⅱ before the first treatment(r =0.623, 0.462, 0.369, P <0.01).Conclusion For patients with severe infection complicated with acute kidney injury, early CRRT treatment can effectively improve the prognosis of patients. In addition to renal function, the timing of treatment should refer to NGAL, BNP,APACHE Ⅱ scores.
作者
张华
ZHANG Hua(Meizhou Hospital of Traditional Chinese Medicine,Meizhou,Guangdong Province,514000 China)
出处
《中外医疗》
2020年第29期55-57,共3页
China & Foreign Medical Treatment
关键词
重症感染
急性肾损伤
血液净化
时机选择
Severe infection
Acute kidney injury
Blood purification
Timing
