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目的观察不同剂量日间连续血液净化(CRRT)治疗严重急性肾损伤的临床疗效。方法选取入住医院ICU的568例接受日间CRRT治疗的急性重症肾损伤患者,按进入本试验的时间顺序编号,用随机数字表双盲法分为A、B、C三组,分别以置换液35 ml/(kg·h)、50 ml/(kg·h)、70 ml/(kg·h)治疗。记录3组患者治疗前后的APACHEⅡ评分、血尿素氮(BUN)值、血肌酐(Scr)值,以观察疗效;根据KDIGO指南评价急性肾损伤预后,采用72 h生存率、好转率等指标判断疗效。结果治疗后3组APACHEⅡ评分、BUN、Scr较治疗前均有所降低,差异均有统计学意义(P<0.05);治疗后B组、C组BUN、Scr水平均低于A组,差异均有统计学意义(P<0.05),B组、C组间BUN、Scr水平比较差异无统计学意义(P>0.05);B、C组72 h生存率高于A组,差异均有统计学意义(P<0.05),B、C组72 h生存率比较无显著差异(P>0.05);A、B、C三组在好转率比较差异无统计学意义(P>0.05)。结论日间CRRT治疗比较合适的置换液剂量50 ml/(kg·h)能有效清除BUN、Scr,降低患者的APACHEⅡ评分,改善短期生存率,进一步增加置换液剂量,并不能进一步改善病情,也与最终转归无明显相关。
Objective To observe the clinical efficacy of different doses of continuous daytime blood purification (CRRT) in the treatment of severe acute kidney injury. Methods A total of 568 patients with acute severe renal injury treated with daytime CRRT were enrolled in the ICU of the hospital and numbered according to the timing of entry into the test. The patients were divided into three groups A, B and C by double-blind random number table, 35 ml / (kg · h), 50 ml / (kg · h), 70 ml / (kg · h). APACHEⅡscore, BUN and Scr were recorded before and after treatment to observe the curative effect. The prognosis of acute renal injury was evaluated according to KDIGO guidelines, and the prognosis was evaluated by 72-hour survival rate and improvement rate . Results After treatment, the APACHEⅡscore, BUN and Scr in three groups were significantly lower than those before treatment (P <0.05), and the levels of BUN and Scr in group B and group C were lower than those in group A after treatment (P <0.05). There was no significant difference in BUN and Scr between group B and group C (P> 0.05). The survival rate of group B and C at 72 h was higher than that of group A (P <0.05). There was no significant difference in 72 h survival rate between groups B and C (P> 0.05). There was no significant difference in improvement rate between groups A, B and C (P> 0.05). Conclusion The daytime CRRT treatment more appropriate replacement dose of 50 ml / (kg · h) can effectively remove BUN, Scr, reduce APACHE Ⅱ score in patients and improve short-term survival rate, and further increase the replacement fluid dose, and can not further improve the condition, but also No significant correlation with the final outcome.