小剂量利尿剂对胱素C的影响
Effect of low dose diuretics on the Angiotensin C

华朋铎.小剂量利尿剂对胱素C的影响[J].内科急危重症杂志,2017,23(5):

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英文关键词:diuretic continuous renal replacement therapy(CRRT) Acute kidney injury(AKI) 引言

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作者	单位	E-mail
华朋铎	南阳市第二人民医院	huapengduotg@163.com

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中文摘要:

目的：分析小剂量利尿剂对胱素C的影响。方法：随机选取2014年3月至2016年3月期间在我院重症医学科就诊接受CRRT的AKI患者。试验组为利尿剂组,患者数为40例,对照组为非利尿剂组,患者数为40例,应用连续肾脏替代治疗急性肾损伤,对机械通气及血管活性药应用、平均动脉压(MAP)、血乳酸、血钾、尿量(均取开始CRRT后起初3d的平均值),开始CRRT前1d、治疗后起初3d肾功能[胱素 C(Cys-C)、SCr、尿素氮(BUN)],CRRT时间、住ICU时间和住院时间等指标进行分析,采用SPSS20.0软件进行统计学分析。结果：(1)性别、年龄、入院至入ICU间隔时间、APACHE Ⅱ评分、SOFA评分、基础疾病、AKI的病因和诊断分类等指标在两组之间无统计学差异,符合试验要求。(2)需血管活性药和有创机械通气指标在两组之间有统计学差异(P<0.05)；MAP指标在利尿剂组和非利尿剂组之间比为72.53±7.68 VS 88.54±15.87,两组之间有显著统计学差异(P<0.01)；乳酸指标在利尿剂组和非利尿剂组之间比为2.21±1.17 VS 2.92±2.74,两组之间有统计学差异(P<0.05)；血钾指标在利尿剂组和非利尿剂组之间比为4.13±1.26 VS 4.83±1.25,两组之间有统计学差异(P<0.05)；CRRT时间指标在利尿剂组和非利尿剂组之间比为5.12±3.53 VS 7.92±5.95,两组之间有显著统计学差异(P<0.01)；住ICU时间指标在利尿剂组和非利尿剂组之间比为15.71±9.56 VS 23.24±17.82,两组之间有显著统计学差异(P<0.01)；住院时间指标在利尿剂组和非利尿剂组之间比为20.57±13.34 VS 27.38±19.83,两组之间有显著统计学差异(P<0.01)。(3)开始CRRT治疗前1d、CRRT治疗后1d和2d,Cys-C、BUN、SCr和尿量在利尿剂组和非利尿剂组之间无统计学差异(P>0.05)；CRRT治疗后3d,Cys-C指标在利尿剂组和非利尿剂组之间比为1.83±1.05 VS 2.45±1.87,两组之间有统计学差异(P<0.05)；BUN指标在利尿剂组和非利尿剂组之间比为12.36±7.87 VS 16.39±7.94,两组之间有统计学差异(P<0.05)；SCr指标在利尿剂组和非利尿剂组之间比为180.25±77.79 VS 205.53±134.83,两组之间有统计学差异(P<0.05)；尿量指标在利尿剂组和非利尿剂组之间比为679.12±643.54 VS 796.49±1608.35,两组之间有统计学差异(P<0.05)。(4)28d内存活指标在利尿剂组和非利尿剂组之间比为32(80.0%)VS 26(65.0%),两组之间有统计学差异(P<0.05)；28d内死亡指标在利尿剂组和非利尿剂组之间比为8(20.0%)VS 14(35.0%),两组之间有统计学差异(P<0.05)。结论：连续肾脏替代治疗急性肾损伤过程中,小剂量利尿剂能降低需血管活性药和有创机械通气的患者数,明显降低MAP,降低血液中乳酸和血钾含量,减少CRRT时间、住ICU时间和住院时间,小剂量利尿剂治疗有助于改善患者的肾功能,治疗后3d,小剂量利尿剂能降低患者血液中Cys-C、BUN和SCr含量,同时减少患者尿量,小剂量利尿剂治疗能提高患者28d内存活数,降低28d内死亡数。

英文摘要:

to analyze the effect of low dose diuretics on the Angiotensin C of CRRT treatment in patients with acute kidney injurylow dose diuretics on the Angiotensin C. Methods: Randomly selecting 80 patients with acute kidney injury (AKI) from March 2014 to March 2016 in our hospital during the period of intensive medicine clinic continuous renal replacement therapy (CRRT), on the basis of the change of urine before CRRT 1 d, which were divided into diuretics groups (urine < 400 ml/h) 40 cases, the non-diuretic group (urine > 400 ml/h) 40 cases,Selecting randomly the treatment of CRRT patients with AKI from March 2014 to March 2016 in our hospital. Test group is a diuretic group, the number of patients for 40 cases, the control group (non diuretic group, the number of patients for 40 patients, application for mechanical entilation and asoactie drugs, mean arterial pressure (MAP), blood lactic acid, potassium, urine volume, before CRRT 1 d, 3 d kidney function at first, after treatment CRRT indices such as time, ICU and hospital stay with SPSS20.0 software for statistical analysisapplication of continuous renal replacement therapy in the treatment of acute kidney injury, of mechanical ventilation and vasoactive drug application, mean arterial pressure (map), blood lactic acid, serum potassium, urine volume, start CRRT at first 3 days average), began to CRRT 1 day before and after treatment at first 3D renal function [cysteine vitamin C (Cys-C), SCR, bun (BUN)], CRRT time, live time and ICU length of stay and other indicators were analyzed, using spss20.0 software was used for statistical analysis. Results: (1) The vascular active drug, invasive mechanical ventilation, MAP, lactic acid, potassium, CRRT, ICU time and hospitalization time index in the two groups had statistically significant differences (P < 0.01)The gender, age, admission to into the ICU time interval, APACHE II score, sofa, underlying diseases, AKI etiology and diagnosis classification index between the two groups are no significant difference, it Meet the test requirements. (2) Before start CRRT treatment 1 d, 1 d and 2 d after CRRT treatment, Cys - C, BUN, SCr and urine in the two groups had no statistical difference (P > 0.05); CRRT treatment after 3 d, Cys - C, BUN, SCr and urine output index in the two groups had statistically difference (P < 0.05)It is to vasoactive medicine and invasive mechanical ventilation index had significant difference between the two groups (P<0.05); MAP index between diuretic group and non diuretic group is 72.53 ± 7.68 VS 88.54 ± 15.87, there were significant differences between the two groups (P<0.01); lactic acid between diuresis group and non agent the diuretic group is 2.21 ± 1.17 VS 2.92 ± 2.74, there were significant differences between the two groups (P<0.05); blood indexes between diuretic group and non diuretic group is 4.13 ± 1.26 VS 4.83 ± 1.25, there were significant differences between the two groups (P<0.05); CRRT index between diuretic group and non diuretic group ratio is 5.12 ± 3.53 VS 7.92 ± 5.95, there were significant differences between the two groups (P<0.01); ICU index between diuretic group and non diuretic group is 15.71 ± 9.56 VS 23.24 ± 17.82, a significant system between the two groups Statistical difference (P<0.01); the length of stay in hospital was 20.57 ± 13.34 VS 19.83 ± 27.38, and there was a significant difference between the two groups (P<0.01). (3) Within 28d the number of cases in the diuretic group is higher than the non-diuretic group [32 (80.0%) VS 26 (65.0%)], within 28d the number of deaths in diuretic group is lower than the non-diuretic group [8 (20.0%) VS 14 (35.0%)], it had statistically difference between the two groups (P < 0.05)CRRT 1d before treatment after treatment of CRRT, 1d and 2d, Cys-C, BUN, SCr and urine volume in the diuretic group and non diuretic group have no significant difference between (P>0.05) After CRRT treatment 3d, Cys-C index between diuretic group and non diuretic group is 1.83 ± 1.05 VS 2.45 ± 1.87. There were significant differences between the two groups (P<0.05); BUN index between diuretic group and non diuretic group is 12.36 ± 7.87 VS 16.39 ± 7.94, there were significant differences between the two groups (P<0.05); SCr index between diuretic group and non diuretic group is 180.25 ± 77.79 VS 205.53 ± 134.83, there is significant difference between the two between the groups (P<0.05); urine volume index between diuretic group and non diuretic group is 679.12 ± 643.54 VS 796.49 ± 1608.35, there were significant differences between the two groups (P<0.05). (4) 28 memory activity indexes between the diuretic group and non diuretic group than 32 (80.0%) vs 26 (65.0%), between the two groups have statistical difference (P < 0.05); 28 days death index ratio between the diuretic group and non diuretic Group 8 (20.0%) vs 14 (35.0%), and between the two groups have significant difference (P < 0.05). Conclusion: In the process of CRRT treatment in patients with AKI, the low-dose diuretics can improve renal function, short the time of CRRT, ICU and hospital stay time, improve the prognosis of patients with AKI.Continuous renal replacement therapy in acute renal injury, small dose of diuretics can reduce the amount of vasoactive drugs and there are a number of patients with mechanical ventilation and significantly reduced map, reduce blood lactic acid and blood potassium levels, reduce the time of CRRT, live time of ICU and hospital stay, small dose of diuretic therapy can improve the renal function of the patients. After 3 days of treatment, small dose of diuretics can reduce in blood of the patients with Cys C, bun and SCR levels, while reducing the urine volume and small dose of diuretics can improve patient 28d memory live number, reduce 28 deaths in the treatment.