高华,黄群英
GAO Hua,HUANG Qunying

• 1:桂林市第二人民医院重症监护室

摘要(Abstract)：

目的 探讨连续性肾脏替代疗法(CRRT)治疗对重症监护室(ICU)急性肾损伤(AKI)患者肾血流动力学的影响。方法 将72例ICU重症AKI患者随机均分为CRRT组和间歇性血液透析(IHD)组，IHD组采取IHD治疗，CRRT组采取CRRT治疗；于治疗前及治疗后1周时检测两组患者血管外肺水指数(EVLWI)、全心舒张末容积指数(GEDVI)、心脏指数(CI)及平均动脉压(MAP),并进行急性生理学及慢性健康状况评分(APACHEⅡ);治疗后1周时，收集两组患者脉冲多普勒血流图，测量两组患者肾血流动力学相关指标，同时采集患者外周静脉血检测血肌酐(Scr)、尿素氮(BUN)水平，检测尿中转铁蛋白(TRF)、尿24 h微量白蛋白(mAlb)、α1-微球蛋白(α1-m)等指标。结果 与治疗前比较，两组患者的EVLWI和GEDVI水平均降低，MAP和CI水平升高，差异有统计学意义(P<0.05);与IHD组比较，CRRT组患者治疗后1周时APACHEⅡ评分较低，差异有统计学意义(P<0.05);CRRT组患者ICU住院时间短于IHD组，差异有统计学意义(P<0.05);与IHD组AKI患者比较，CRRT组SRA和IRA的Vs、Vd升高，而PI、RI、AT降低，差异有统计学意义(P<0.05);与IHD组AKI患者比较，CRRT组Cystatin C、ET、Scr、BUN、Alb/Scr、TRF/Scr、NAG/Scr、α1-m/Scr降低，差异有统计学意义(P<0.05)。结论 CRRT治疗可有效稳定重症AKI患者肾血流动力学，缩短住院时间。
Objective To investigate the effect of continuous renal replacement therapy(CRRT) on renal hemodynamics in patients with acute renal injury(AKI) in intensive care unit(ICU). Methods Seventy-two ICU patients with severe AKI were randomly divided into CRRT group and IHD group. IHD group was treated with intermittent hemodialysis(IHD), while CRRT group was treated with continuous renal replacement therapy(CRRT). The extravascular lung water index(EVLWI), global end diastolic volume index(GEDVI), cardiac index(CI), and mean arterial pressure(MAP) were measured before and 1 week after treatment, and the acute physiology and chronic health status score(APACHE Ⅱ) were also measured. After one week of treatment, Pulse Doppler blood flow diagrams of patients in both groups were collected to measure the renal hemodynamics related indexes of patients in both groups, and the peripheral venous blood of patients was collected to detect the levels of serum creatinine(Scr), urea nitrogen(BUN), urinary transferrin(TRF), urinary microalbumin(mAlb) in 24 hours, and α1-microglobulin(α1-m). Results After treatment, EVLWI, and GEDVI levels decreased, while MAP and CI levels increased in both groups(P<0.05). Compared with the control group, the levels of EVLWI and GEDVI in the study group were lower, while the levels of MAP and CI were higher(P<0.05). There was no significant difference in APACHE Ⅱscores between the two groups before treatment(P>0.05). Compared with the control group, the APACHE Ⅱ score of the study group was lower after treatment, and the difference was statistically significant(P<0.05). The length of stay in ICU in the study group was lower than that in the control group, with a statistically significant difference(P<0.05). Compared with the control group, the Vs and Vd of SRA and IRA in the study group were higher, while PI, RI, and AT were lower, with a statistically significant difference(P<0.05). Compared with the control group, Cystatin C, ET, Scr, BUN, Alb/Cr, TRf/Cr, NAG/Cr, α1-m/Cr was lower, the difference was statistically significant(P<0.05). Conclusion For patients with AKI in the ICU, the treatment with CRRT can shorten the time of patients' ICU stay, and improve their renal hemodynamic levels.

关键词(KeyWords)： 连续性肾脏替代;重症急性肾损伤;临床疗效;肾血流动力学
continuous renal replacement;severe acute kidney injury(AKI);clinical effect;renal hemodynamics

Abstract:

Keywords:

基金项目(Foundation): 广西壮族自治区卫生厅自筹经费科研课题(Z2014264)

作者(Author): 高华,黄群英
GAO Hua,HUANG Qunying

DOI: 10.19367/j.cnki.2096-8388.2023.02.016

参考文献(References)：

• [1]RONCO C,BELLOMO R,KELLUM J A.Acute kidney injury[J].Lancet,2019,394(10212):1949-1964．
• [2]DUTTA A,HARI K J,AZIZIAN J,et al.Incidence,predictors,and prognosis of acute kidney injury among cardiac arrest survivors[J].Intensive Care Med,2021,36(5):550-556．
• [3]S?VIK S,ISACHSEN M S,NORDHUUS K M,et al.Acute kidney injury in trauma patients admitted to the ICU:a systematic review and meta-analysis[J].Intensive Care Med,2019,45(4):407-419．
• [4]杨丽娜，马良，付平．转录激活因子3在急性肾损伤及慢性肾脏病中的作用机制研究进展[J]．中国实用内科杂志，2021,41(2):163-166．
• [5]MATUSZKIEWICZ-ROWINSKA J,MA?YSZKO J.Acute kidney injury,its definition,and treatment in adults:guidelines and reality[J].Pol Arch Intern Med,2020,130(12):1074-1080．
• [6]PANAPUT T,PEERAPORNRATANA S,SIRIVONGRAN-GSON P,et al.Modalities of renal replacement therapy and clinical outcomes of patients with acute kidney injury in a resource-limited setting:Results from a SEA-AKIstudy[J].Crit Care,2021,65(1):18-25．
• [7]KARKAR A,RONCO C.Prescription of CRRT:a pathway to optimize therapy[J].Ann Intensive Care,2020,10(1):32．
• [8]肖德．连续性肾脏替代治疗对急性肾损伤患者临床疗效和外周血T淋巴细胞及炎性相关因子的影响[J]．检验医学与临床，2022,19(15):2134-2136．
• [9]汤晓静，梅长林．KDIGO指南解读:急性肾损伤的诊治[J]．中国实用内科杂志，2012,32(12):914-917．
• [10]KOEZE J,KEUS F,DIEPERINK W,et al.Incidence,timing and outcome of AKI in critically ill patients varies with the definition used and the addition of urine output criteria[J].BMC Nephrol,2017,18(1):70．
• [11]LI F,LIU L,CHEN D,et al.Efficacy of three renal replacement therapy modalities for the treatment of acute kidney injury caused by wasp sting[J].Blood Purif,2022,51(4):365-375．
• [12]WANG J,WU Z,WEN Q,et al.Effects of CRRT on renal function and toxin clearance in patients with sepsis:a case-control study[J].Int Med Res,2021,49(9):3000605211042981．
• [13]BALDWIN I,MOTTES T.Acute kidney injury and continuous renal replacement therapy:a nursing perspective for my shift today in the intensive care unit[J].Semin Dial,2021,34(6):518-529．
• [14]OSTERMANN M,CONNOR M,J R,KASHANI K.Continuous renal replacement therapy during extracorporeal membrane oxygenation:why,when and how[J].Curr Opin Crit Care,2018,24(6):493-503．
• [15]MURPHY H J,EKLUND M J,HILL J,et al.Early continuous renal replacement therapy during infant extracorporeal life support is associated with decreased lung opacification[J].Artif Organs,2019,22(4):286-293．
• [16]AZIMI-GHOMI O,MILLER G,GUIDA C,et al.The novel use of continuous renal replacement therapy and nitric oxide in the treatment of acute respiratory failure in HELLP syndrome[J].Case Rep Crit Care,2021,2021(1):8895319．
• [17]BAEK S D,KANG J Y,YU H,et al.Change in alkaline phosphatase activity associated with intensive care unit and hospital length of stay in patients with septic acute kidney injury on continuous renal replacement therapy[J].BMC Nephrol,2018,19(1):243．
• [18]PEERAPORNRATANA S,MANRIQUE-CABALLERO CL,GóMEZ H,et al.Acute kidney injury from sepsis:current concepts,epidemiology,pathophysiology,prevention and treatment[J].Kidney Int,2019,96(5):1083-1099．
• [19]CHEN W Y,CAI L H,ZHANG Z H,et al.The timing of continuous renal replacement therapy initiation in sepsis-associated acute kidney injury in the intensive care unit:the CRTSAKI Study (Continuous RRT Timing in Sepsis-associated AKI in ICU):study protocol for a multicentre,randomised controlled trial[J].BMJ Open,2021,11(2):e040718．
• [20]SATO R,LUTHE S K,NASU M.Blood pressure and acute kidney injury[J].Crit Care,2017,21(1):28.

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