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| ECMO期间CRRT启动时机对急性肾损伤患者预后的影响 |
| Impact of CRRT initiation timing during ECMO on prognosis of patients with AKI |
| 投稿时间：2026-03-25 |
| DOI：10.3969/j.issn.1000-0399.2026.09.004 |
| 中文关键词: 体外膜肺氧合 连续性肾脏替代治疗 急性肾损伤 生存分析 预后 |
| 英文关键词: Extracorporeal membrane oxygenation Continuous renal replacement therapy Acute kidney injury Survival analysis Prognosis |
| 基金项目:安徽省临床医学研究转化专项(编号:202304295107020046) |
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| 中文摘要: |
| 目的 探讨体外膜肺氧合（ECMO）期间连续肾脏替代治疗（CRRT）启动时机对急性肾损伤（AKI）患者预后的影响。方法 回顾性分析2018年6月至2024年8月于安徽医科大学第一附属医院重症医学科接受ECMO治疗并合并AKI的99例患者临床资料。根据CRRT启动时机不同，分为早期CRRT干预组（AKI 3期诊断后24小时内启动，n=40）和延迟CRRT干预组（AKI 3期诊断24小时后启动，n=59）。比较两组患者基线特征、治疗后第3天的肾功能变化、ECMO成功撤机率、28天全因死亡率，并进行Kaplan-Meier生存分析。结果 两组患者基线资料比较，差异无统计学意义（P>0.05）。CRRT治疗后第3天，早期CRRT干预组血清肌酐水平下降更为明显（P<0.05）。早期CRRT干预组ECMO成功撤机率高于延迟CRRT干预组（P<0.05），早期CRRT干预组ICU住院时间和总住院时间较延迟CRRT干预组短（P<0.05）。Kaplan-Meier分析结果显示，早期CRRT干预组的28天全因死亡率低于延迟CRRT干预组（P<0.05）。结论 ECMO期间早期启动CRRT与AKI患者血肌酐清除效率有一定相关性，在优化预后方面具有潜在临床价值。 |
| 英文摘要: |
| Objective To evaluate the effects of the timing of initiation of the continuous renal replacement therapy(CRRT) during extracorporeal membrane oxygenation(ECMO) on the prognosis of patients with acute kidney injury(AKI). Methods A retrospective analysis was conducted on the clinical data of 99 patients with AKI who received ECMO treatment at the Department of Critical Care Medicine of the First Affiliated Hospital of Anhui Medical University from June 2018 to August 2024. Based on the timing of CRRT initiation, the patients were divided into an early CRRT intervention group(initiated more than 24 hours after AKI stage 3 diagnosis, n=40) and a delayed CRRT intervention group(initiated 24 hours after AKI stage 3 diagnosis, n=59). Baseline demographics, changes in renal function on the third day after CRRT initiation, ECMO weaning success rates, and 28-day all-cause mortality rates were compared between the two groups, followed by KaplanMeier survival analysis. Results There were no significant differences in baseline characteristics between the two groups(P>0.05). On the third day after CRRT treatment, the serum creatinine levels in the early CRRT intervention group decreased more significantly(P<0.05). Regarding prognostic outcomes, the ECMO weaning success rate in the early CRRT intervention group was higher than that in the delayed CRRT intervention group(P<0.05). Additionally, the lengths of ICU stay time and total hospital stay were significantly shorter in the early CRRT intervention group than in the delayed CRRT intervention group(P<0.05). The Kaplan-Meier analysis results showed that the 28-day all-cause mortality rate in the early CRRT intervention group was lower than that in the delayed CRRT intervention group(P<0.05). Conclusion The early initiation of CRRT during ECMO is correlated with the renal clearance efficiency of serum creatinine in patients with AKI, and shows potential clinical value in optimizing prognosis. |
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