早期应用连续性肾代替治疗对体外膜肺氧合支持重症患者预后影响临床研究

摘要

目的 观察早期应用连续性肾代替治疗(Continuousrenal replacement therapy,CRRT)对体外膜肺氧合(Extracorporeal membrane oxygenation,ECMO)救治患者预后的影响.方法 采用前瞻性随机对照试验方法,将2015年1月至2017年12月本院收治的46例需ECMO支持、出现急性肾损伤(Acute kidney injury,AKI)成年患者随机分为早期治疗组和常规治疗组,根据肾损伤分期确定CRRT治疗介入时间,观察两组患者基本资料、ECMO辅助时间、机械通气时间、肾代替时间、ICU治疗时间、肾功能转归等情况,并进行统计分析.结果 两组患者基本资料差异无统计学意义,早期治疗组患者ECMO辅助时间为(140.86±22.35)h、机械通气支持时间为(12.36±3.37)d、肾代替时间为(17.43±4.26)d、ICU治疗时间为(20±5.35)d,液体超负荷发生7例,均明显优于常规治疗组.结论 对体外膜肺氧合支持治疗的重症患者在出现急性肾损伤早期,予行肾代替治疗可减少ECMO辅助时间、机械通气时间、肾代替时间及ICU治疗时间,减少患者液体超负荷发生率,有利于减少治疗费用及改善预后.%Objective To observe the effect of early continuous renal replacement therapy (CRRT) on the prognosis of patients treated by extracorporeal membrane oxygenation (ECMO).Methods 46 patients with acute kidney injury (AKI) taking ECMO support in our hospital from January,2015 to December,2017 were randomly divided into an early treatment group and a conventional treatment group.According to the stage of renal injury,the CRRT treatment intervention time was determined.The basic data,ECMO auxiliary time,mechanical ventilation time,renal replacement time,ICU treatment time,renal function outcomes were observed and statistically analyzed.Results There were no statistical differences in the basic data between the two groups.The ECMO-assisted time,mechanical ventilation support time,renal replacement time,and ICU treatment time were shorter and the number of fluid overload cases was lower in the early treatment group than in the conventional treatment group.Conclusions The use of renal replacement therapy in the early stage of acute kidney injury in critically ill patients taking extracorporeal membrane oxygenation support can reduce the ECMO-assisted time,mechanical ventilation time,renal replacement time,and ICU treatment time,as well as the incidence of fluid overload and treatment cost,and improve the prognosis.