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早期CRRT联合甲磺酸萘莫司他用于SA-AKI的临床疗效分析
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| 篇名： | 早期CRRT联合甲磺酸萘莫司他用于SA-AKI的临床疗效分析 |
| TITLE： | Analysis of clinical efficacy of early CRRT combined with nafamostat mesylate for SA-AKI |
| 摘要： | 目的 探讨早期连续性肾脏替代治疗（CRRT）联合甲磺酸萘莫司他（NM）对脓毒症相关性急性肾损伤（SA-AKI）患者的临床结局、安全性及炎症反应和氧化应激的影响。方法收集2023年1月至2025年1月我院重症医学科收治的诊断为SA-AKI后48h内启动CRRT的153例患者资料，根据CRRT期间所用抗凝药物的不同，将其分为对照组（75例）和观察组（78例）。CRRT启动后，对照组患者给予枸橼酸钠，观察组患者给予NM。比较两组患者的临床结局指标[机械通气时间、重症医学病房（ICU）住院时间以及治疗前后的急性生理学和慢性健康评估（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分]、肾功能指标[血肌酐（Scr）、血尿素氮（BUN）、血清胱抑素C（CysC）]、炎症指标[C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素6（IL-6）]、氧化应激指标[丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）]及不良反应发生情况。结果治疗后，观察组患者的机械通气时间和ICU住院时间均显著短于对照组（P＜0.05）；两组患者的APACHEⅡ评分、SOFA评分、肾功能指标、炎症指标、MDA水平均显著低于同组治疗前（P＜0.05），且观察组显著低于对照组（P＜0.05）；两组患者的SOD、GSH-Px水平均显著高于同组治疗前（P＜0.05），且观察组显著高于对照组（P＜0.05）。两组患者的不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论与早期CRRT联合枸橼酸钠相比，早期CRRT联合NM可改善SA-AKI患者的肾功能，减轻炎症反应与氧化应激程度，缩短ICU住院时间，且安全性相当。 |
| ABSTRACT： | OBJECTIVE To investigate the effects of early continuous renal replacement therapy （CRRT） combined with nafamostat mesylate （NM） on clinical outcomes， safety， inflammatory reaction， and oxidative stress in patients with sepsis- associated acute kidney injury （SA-AKI）. METHODS Patients’ data were gathered from 153 cases admitted to the intensive care unit of the our hospital between January 2023 and January 2025， who initiated CRRT within 48 hours after being diagnosed with SA-AKI. These patients were divided into control group （75 cases） and observation group （78 cases） according to different anticoagulant drugs used during CRRT. After CRRT， control group was given sodium citrate， while observation group was given NM. The clinical outcomes [the duration of mechanical ventilation， length of stay in the intensive care unit （ICU）] as well as Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score， Sequential Organ Failure Assessment （SOFA） score， renal function indexes [serum creatinine （Scr）， blood urea nitrogen （BUN）， cystatin C （CysC）]， inflammatory indexes [C-reactive protein （CRP）， procalcitonin （PCT）， interleukin-6 （IL-6）]， oxidative stress markers [malondialdehyde （MDA）， superoxide dismutase （SOD）， glutathione peroxidase （GSH-Px）] and the occurrence of adverse drug reactions before and after treatment were compared between the two groups. RESULTS After treatment， the observation group had significantly shorter mechanical ventilation duration and ICU length of stay compared to the control group （P＜0.05）. APACHE Ⅱ scores， SOFA scores， renal function indexes， inflammatory indexes and MDA levels of two groups were significantly lower than those before treatment within the same group （P＜0.05）， and the observation group were significantly lower than the control group （P＜0.05）. The levels of SOD and GSH-Px were significantly higher than those before treatment within the same group （P＜0.05）， and the observation group were significantly higher than the control group （P＜0.05）. There was no statistically significant difference in the overall incidence of adverse events between the two groups （P＞0.05）. CONCLUSIONS Compared with early CRRT combined with sodium citrate， early CRRT combined with NM can significantly improve renal function in patients with SA-AKI， alleviate the degree of inflammatory reaction and oxidative stress， shorten ICU stay length， and demonstrate favorable safety. |
| 期刊： | 2026年第37卷第03期 |
| 作者： | 李欣慧；辛娜 |
| AUTHORS： | LI Xinhui，XIN Na |
| 关键字： | 脓毒症相关性急性肾损伤；连续性肾脏替代治疗；甲磺酸萘莫司他；抗凝；炎症反应；氧化应激 |
| KEYWORDS： | sepsis-associated acute kidney injury； continuous renal replacement therapy； nafamostat mesylate； anticoagulation； |
| 阅读数： | 3 次 |
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