摘要
目的:探讨血浆中性粒细胞明胶酶相关脂质转运蛋白(pNGAL)水平对指导腹腔感染急性肾损伤(AKI)患者选择连续性肾脏替代治疗(CRRT)时机的作用。方法:将2016-01—2019-01期间我院外科ICU收治的80例腹腔感染并发AKI行CRRT的患者分为两组,pNGAL值为245~417 ng/mL的40例患者为pNGAL组;按常规行CRRT的40例患者为对照组。对比不同组别患者血管活性药物使用率、入ICU到开始CRRT时间、CRRT使用时间、机械通气时间、ICU住院时间、乳酸、降钙素原(PCT)、尿素氮(BUN)、pNGAL、肌酐(Cr)、尿量、急性生理与慢性健康状况评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分)并绘制生存曲线。结果:pNGAL组患者入ICU到开始CRRT时间、CRRT使用时间、机械通气时间及ICU住院时间较对照组缩短,差异有统计学意义(P<0.05)。行CRRT 0 h时,pNGAL组的PCT、BUN、pNGAL、Cr、APACHEⅡ评分和SOFA评分比对照组低,pNGAL组的尿量高于对照组,差异有统计学意义(P<0.05)。行CRRT 24 h及48 h后,两组的PCT、BUN、pNGAL、Cr和尿量较CRRT 0 h时明显改善(P<0.05);pNGAL组的PCT、BUN、pNGAL、Cr、APACHEⅡ评分和SOFA评分较对照组低,pNGAL组的尿量较对照组高,差异有统计学意义(P<0.05)。两组患者的生存分析显示,pNGAL组患者的28 d生存率较对照组高(P=0.023)。结论:pNGAL水平可用于指导腹腔感染并发AKI患者选择CRRT的时机,早期CRRT可提高患者28 d生存率。
Objective:To explore the effect of plasma neutrophil gelatinase-associated lipocalin level on the timing of continuous renal replacement therapy in patients with acute renal injury caused by abdominal infection. Method:We selected 80 cases of abdominal cavity infection with acute kidney injury patients who were treated with CRRT in our hospital surgical ICU from January 2016 to January 2019. Patient with pNGAL ranging from 245 ng/mL to 417 ng/mL was categorized as pNGAL group(40 cases), while the others as conventional CRRT control group(40 cases). The utilization rate of vasoactive agents, time from ICU admission to CRRT, CRRT time, mechanical ventilation time, ICU stay and the changes of lactic acid, procalcitonin, blood urea nitrogen(BUN), pNGAL, creatinine(Cr), urine volume, parallel acute physiology and chronic health evaluation(APACHE Ⅱ score), sequential organ failure assessment score(SOFA score) were compared. Result:The time from ICU admission to CRRT, CRRT time, mechanical ventilation time and ICU stay are shorter in pNGAL group than those in control group, with statistically significant differences(P<0.05). When CRRT 0 h was performed, BUN, pNGAL, Cr, APACHEⅡ score and SOFA score in pNGAL group were lower than those in control group(P<0.05), while the urine volume of pNGAL group was significantly higher than that of control group(P<0.05). After CRRT 24 h and 48 h treatment, BUN, pNGAL, Cr, urine volume and APACHE Ⅱ scores in the two groups were significantly improved compared with that CRRT 0 h, with statistically significant difference(P<0.05). PCT, BUN, pNGAL, Cr, APACHE Ⅱ and SOFA scores in pNGAL group were lower than those in control group, with statistically significant difference(P<0.05), while the urine volume of pNGAL group was significantly higher than that of control group(P<0.05). The survival analysis of patients in the two groups showed that the 28-day survival rate was higher in the pNGAL group(P=0.023). Conclusion:For patients with abdominal infection complicated with acute kidney injury, the pNGAL level can be referred to select the timing of CRRT, and the early initiation of CRRT is beneficial to improve the 28-day survival rate.
作者
施建设
陈佳海
蓝亮光
艾叶青
郑佳隆
刘卉芳
郭冰泉
潘志强
张诚华
SHI Jianshe;CHEN Jiahai;LAN Liangguang;AI Yeqing;ZHENG Jialong;LIU Huifang;GUO Bingquan;PAN Zhiqiang;ZHANG Chenghua(Department of General Surgical ICU,the 910^th Hospital of PLA,Quanzhou,Fujian,362000,China;Department of Clinical Laboratory,the 910^th Hospital of PLA)
出处
《临床急诊杂志》
CAS
2020年第3期212-217,共6页
Journal of Clinical Emergency
基金
泉州市科技计划项目资助(No:2016Z063).
作者简介
通信作者:张诚华,E-mail:zch180@263.net
