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张丽霞 徐铁领 王智勇 摘要
河北医科大学第三医院重症医学科 050051 目的：探讨急性肾损伤（acute kidney injury，AKI）早期肾脏替代治疗（Continuous
renal replacement therapy，CRRT）对多发创伤患者预后的影响。方法：2010年5月至
2014年6月我院ICU收治的79例多发创伤伴肾损伤患者，分为肾损伤早期CRRT（AKI-CRRT）
组和肾损伤肾衰竭CRRT（AKIARF-CRRT）组，对两组间APACHEII评分、ISS评分、肾替代治
疗时间、机械通气时间、住ICU时间、28天病死率进行比较。结果：AKI-CRRT组与AKIARF-
CRRT组比较，肾替代治疗时间(41.4±6.2h vs 65±11.4h)、机械通气时间(44.6±23.1h
v s 54.2±22.7h)、住I C U时间(6.2±4.3d v s 3.3±2.1d)、多脏器功能衰竭发生率
(20.9%v s34.2%)、28天病死率(2.6%v s6.3%)。统计学分析均具有显著性差异。结论：轻微
肾损伤可以影响多发创伤患者的治疗效果，早期识别肾损伤有助于早期治疗干预，早期实
施血液净化治疗有助于改善总体预后。
关键词：急性肾损伤；多发创伤；连续肾脏替代治疗
责任作者与联系方式：王智勇，E-mail: ICUW@sohu.com
早期连续肾替代治疗对创伤并急性肾损伤患
者的治疗效果
The Effect of CRRTTreated Multiple-traumaPatientswith Acute
Kidney Injury
L. X. Zhang, T. L. Xu, Z. Y. Wang
Department of Critical Care Medicine, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Abstract
Objective. To investigate the effect of the implementation of Continuous renal replacement therapyearly onmultiple-
trauma patients with acute kidney injury.
Methods. 79multiple-trauma patients were retrospectively analyzed, who were admitted to ICU in our hospital from May
2010 to June 2014.They were then separated into AKI-CRRT and AKIARF-CRRT group.The main end points were APACHE II score,
ISS score, length of renal replacement therapy, length of mechanical ventilation, length of stay in the ICU, rate of MODS and28-
day mortality rate.
Results. The two groups were similar in regard to age, sex, APACHE II score and ISS score.Compared withAKI-CRRT and
AKIARF-CRRTgroups,length of renal replacement therapy(41.4±6.2h vs 65±11.4h), length of mechanical ventilation(44.6
±23.1hvs54.2±22.7h), length of stay in the ICU(3.3±2.1dvs6.2±4.3d)、rate of MODS(20.9%vs34.2%)and 28-day mortality
rate(2.6%vs6.3%) were significantly greater in AKI group(P<0.05).
Conclusions. AKI is deleterious to critically multiple trauma patients. The effort to avert continued rises in creatinine might
improve outcome in critically injured trauma patients.
Key Words: Acute kidney injury;Multiple trauma;CRRT
Corresponding Author: Zhi-yong Wang, E-mail: ICUW@sohu.com
多发创伤患者易合并肾功能障碍，一旦肾功能受损，随 报道。本文依据RIFLE分层诊断标准确定急性肾损伤，对急性
之而来的是内环境紊乱，酸碱失衡、容量状态失去自我调 肾损伤及早期肾替代治疗与常规到肾衰竭后再行肾替代治疗
节，呼吸功耗增加、肺顺应性降低、体内炎症介质清除减 作比较，研究早期肾替代治疗对多发创伤伴肾损伤患者的治
少，免疫功能紊乱加重[1]。以往常待急性肾衰方进行肾脏替 疗效果。
代治疗，患者病死率高。近年来国际肾脏病及重症医学界提
出急性肾损伤概念，旨在早期识别肾功能的异常，早期干 一、资料与方法
预。肾功能障碍和早期干预治疗对创伤患者预后的影响罕有
1.一般资料
Laboratory aRnedviCewlinaicnadl CInMveEsLtiegcattuioren 33 FAM 2015 Jan/Feb Vol.22 Issue 1
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