Dai Tian, Cao Shuhua, Yang Xiaolong
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2016 Mar;28(3):277-80.
To compare the clinical effects between continuous renal replacement therapy (CRRT) and intermittent haemodialysis (IHD) for the treatment of sepsis-induced acute kidney injury (AKI).
A prospective study was conducted. Seventy-three patients with sepsis-induced AKI admitted to the intensive care units (ICUs) of Tianjin Hospital and Tianjin First Center Hospital from January to December in 2014 were enrolled. They were randomly divided into two groups: CRRT group (n = 35) and IHD group (n = 38). Data were recorded for the patients in two groups before treatment, including acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, mean arterial pressure (MAP), urine volume, and the levels of C-reactive protein (CRP) and serum creatinine (SCr) before and 1 week after treatment, the time of recovery of urine volume, the length of ICU stay, the duration of organ support, and the incidence of cardiovascular events.
There was no statistically significant difference in APACHE Ⅱ scores (21.63±2.46 vs. 21.34±2.46), MAP [mmHg (1 mmHg = 0.133 kPa): 71.26±10.70 vs. 75.74±15.17], urine volume (mL: 404.00±79.13 vs. 438.97±87.17), CRP (mg/L: 100.94±14.73 vs. 95.17±27.03), and SCr (μmol/L: 394.02± 50.26 vs. 390.47±54.42) before treatment between CRRT group and IHD group (all P > 0.05). One week after treatment, compared to the IHD group, CRRT could dramatically reduce the levels of CRP (mg/L: 41.05±10.15 vs. 60.21±14.78, t = 6.401, P < 0.001), SCr (μmol/L: 185.97±65.48 vs. 232.02±71.93, t = 2.862, P = 0.006), urine output recovery time (days: 7.94±3.06 vs. 11.08±3.71, t = 3.923, P < 0.001), the length of ICU stay (days: 9.54±3.39 vs. 13.42±3.89, t = 4.521, P < 0.001), organ support time (days: 3.23±2.70 vs. 6.34±3.36, t = 4.343, P < 0.001), and the incidence of cardiovascular events [23.53% (8/35) vs. 39.47% (15/38), χ2 = 5.509, P = 0.025].
Compared to IHD, CRRT can more efficiently help patients with sepsis-induced AKI in removing excessive water, metabolic waste, and lower the levels of pro-inflammatory cytokines, maintain homeostasis of the internal environment, lower the adverse effects on cardiovascular system, so that it significantly improve the prognosis of patients, shorten the time of organ support and the length of ICU stay.
比较持续肾脏替代治疗（CRRT）与间歇性血液透析（IHD）治疗脓毒症诱导的急性肾损伤（AKI）的临床效果。
进行一项前瞻性研究。纳入2014年1月至12月在天津医院和天津市第一中心医院重症监护病房（ICU）收治的73例脓毒症诱导的AKI患者。将他们随机分为两组：CRRT组（n = 35）和IHD组（n = 38）。记录两组患者治疗前的数据，包括急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、平均动脉压（MAP）、尿量，以及治疗前和治疗1周后的C反应蛋白（CRP）和血清肌酐（SCr）水平、尿量恢复时间、ICU住院时间、器官支持时间和心血管事件发生率。
CRRT组和IHD组治疗前的APACHEⅡ评分（21.63±2.46 vs. 21.34±2.46）、MAP[mmHg（1 mmHg = 0.133 kPa）：71.26±10.70 vs. 75.74±15.17]、尿量（mL：404.00±79.13 vs. 438.97±87.17）、CRP（mg/L：100.94±14.73 vs. 95.17±27.03）和SCr（μmol/L：394.02±50.26 vs. 390.47±54.42）比较，差异均无统计学意义（均P > 0.05）。治疗1周后，与IHD组相比，CRRT能显著降低CRP水平（mg/L：41.05±10.15 vs. 60.21±14.78，t = 6.401，P < 0.001）、SCr水平（μmol/L：185.97±65.48 vs. 232.02±71.93，t = 2.862，P = 0.006）、尿量恢复时间（天：7.94±3.06 vs. 11.08±3.71，t = 3.923，P < 0.001）、ICU住院时间（天：9.54±3.39 vs. 13.42±3.89，t = 4.521，P < 0.001）、器官支持时间（天：3.23±2.70 vs. 6.34±3.36，t = 4.343，P < 0.001）以及心血管事件发生率[23.53%（8/35）vs. 39.47%（15/38），χ2 = 5.509，P = 0.025]。
与IHD相比，CRRT能更有效地帮助脓毒症诱导的AKI患者清除过多水分和代谢废物，降低促炎细胞因子水平，维持内环境稳态，减轻对心血管系统的不良影响，从而显著改善患者预后，缩短器官支持时间和ICU住院时间。
