中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (08): 486-489.doi: 10.3969/j.issn.1671-4091.2015.08.011

• 临床研究 • 上一篇    下一篇

重症急性胰腺炎合并急性肾损伤行连续性肾替代治疗开始时机

韩莉1,张凌2,康焰1   

  1. 1. 四川大学华西医院ICU
    2. 四川大学华西医院肾内科
  • 收稿日期:2015-01-19 修回日期:2015-07-01 出版日期:2015-08-12 发布日期:2015-08-12
  • 通讯作者: 康焰 kangyan@vip.sina.com E-mail:kangyan@vip.sina.com

The initiation time of continuous renal replacement therapy for severe acute pancreatitis patients complicatedwith acute kidney injury

  • Received:2015-01-19 Revised:2015-07-01 Online:2015-08-12 Published:2015-08-12

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摘要： 【摘要】目的探讨重症急性胰腺炎(severe acute pancreatitis，SAP)合并急性肾损伤(acutekidney injury，AKI)时连续性肾替代治疗(continuous renal replacement therapy ，CRRT)开始时机。方法回顾性分析2010～2013 年合并AKI 的SAP 患者病例资料，根据KDIGO 的AKI1～3 期分级标准将患者分为开始CRRT 早(AKI1、2 期) 和开始晚(AKI 3 期)2 组，比较患者人口学特征，开始CRRT 时的临床数据，预后指标是60 天ICU 住院病死率和ICU 住院时间。结果84 例合格患者纳入分析，早期开始CRRT 组27 例，晚期CRRT 组57 例。早晚2 组的60 天ICU 住院病死率分别为为30%(9/27)和59.3%(32/57)，差异具有统计学意义(c2=6.608，P =0.010)；并且开始早的患者的ICU 住院时间更短[HR:0.392(95% CI: 0.169～0.776)，P =0.009]。结论合并AKI 的SAP 患者的CRRT 宜在AKI早期(1 和2 期)开始。

关键词: 重症急性胰腺炎, 急性肾损伤, 连续性肾替代治疗, 开始时机

Abstract: 【Abstract】Objective To explore the initiation time of continuous renal replacement therapy (CRRT) for severe acute pancreatitis (SAP) patients complicated with acute kidney injury (AKI). Methods SAP patients with AKI admitted to West China Hospital of Sichuan University and received CRRT during the period
from Jan. 2010 to Dec. 2013 were retrospectively analyzed. They were divided into early CRRT group (initiated at AKI stage 1 or 2) and late CRRT group (initiated at AKI stage 3). Demographic information and clinical data at the initiation of CRRT, and prognosis including the 60～day-ICU mortality and the retained days in ICU were compared between the two groups. Results A total of 84 patients were analyzed, 30 patients in the early CRRT group and 57 patients in the late CRRT group. The 60-day-ICU mortality was 30% (9/27) in the early CRRT group and was 59.3% (32/57) in the late CRRT group (c2=6.608, P=0.010). The retained days in ICU was shorter in the early CRRT group than in the late CRRT group (HR=0.392, 95% CI: 0.169～0.776; P=0.009). Conclusion CRRT performed at the early stage (at AKI stage 1 or 2) may be optimal for the treatment of SAP patients complicated with AKI.

Key words: severe acute pancreatitis, acute kidney injury, continuous renal replacement therapy, time of initiation