Application Of CRRT In Volume Management Of Patients With Sepsis Complicated With AKI And Its Effect On Prognosis

Objective:Objective To investigate the application of continuous renal replacement therapy(CRRT)in volume management of patients with acute kidney injury(AKI)caused by sepsis and its effect on prognosis.Methods:In this study,patients with septic AKI who were hospitalized for CRRT treatment in the intensive care Department of our hospital from September 2020 to December 2021 were selected.According to the 2018 Guidelines for the diagnosis and treatment of Heart failure in China,patients were divided into two groups: AKI group without heart failure and AKI group with heart failure.Both groups were treated with CRRT on the basis of conventional treatment.Volumetric indexes before and after CRRT treatment were recorded,including mean arterial pressure,central venous pressure(CVP),and respiratory variation rate of inferior vena cava.Cardiac function indicators: left ventricular end-diastolic diameter,left ventricular ejection fraction,N-terminal pro-B-type Natriuretic peptide(NT-prob NP);Secondary outcome measures: serum creatinine,blood urea nitrogen,sequential organ failure Assessment(SOFA).Changes of volume-related indicators,cardiac function indicators and secondary indicators in2 groups were observed before and after treatment.Data were analyzed by SPSS22.0statistical software to evaluate the application of CRRT in volume management of patients with sepsis induced AKI and its impact on prognosis.Results:1.A total of 39 patients with AKI caused by sepsis were collected in this study.Among them,there were 20 cases in AKI group without heart failure,and 19 cases in AKI group with heart failure.The general data between the two groups: gender,age,height,weight and primary disease had no difference(P > 0.05),and the two groups were comparable.2.Comparison before and after treatment in the group without HEART failure:(1)Volume index: there were no differences in mean arterial pressure and CVP before and after treatment(P > 0.05);The rate of respiratory variation in inferior vena cava was higher than that before treatment(P < 0.05).(2)Cardiac function indexes: left ventricular end-diastolic diameter and left ventricular ejection fraction had no difference before and after treatment(P > 0.05);Nt-probnp decreased compared with before treatment(P < 0.05);(3)Secondary indicators: serum creatinine,blood urea nitrogen and SOFA score were all lower than before treatment(P < 0.05).3.Comparison of heart failure group before and after treatment:(1)Volume index: mean arterial pressure before and after treatment had no difference(P > 0.05),CVP decreased compared with before treatment(P < 0.05),and the rate of respiratory variation in inferior vena cava increased compared with before treatment(P < 0.05);(2)Cardiac function indicators: left ventricular end-diastolic diameter decreased compared with before treatment(P < 0.05),left ventricular ejection fraction increased compared with before treatment(P <0.05),NT-prob NP decreased compared with before treatment(P < 0.05);(3)Secondary indicators: serum creatinine,blood urea nitrogen and SOFA score were all lower than before treatment(P < 0.05).4.Comparison before and after treatment between the group without HEART failure and the group without heart failure:(1)Volume index: before treatment,CVP in the group without heart failure was higher than that in the group without heart failure(P < 0.05),and the rate of respiratory variation in inferior vena cava was lower than that in the group without heart failure(P < 0.05);After treatment,CVP and respiratory variation rate of inferior vena cava were improved and there was no difference between the two groups(P > 0.05).(2)Cardiac function indicators: before treatment,the left ventricular end-diastolic diameter and NT-prob NP in the heart failure group were higher than those in the group without heart failure(P < 0.05),and the left ventricular ejection fraction was lower than that in the group without heart failure(P < 0.05);After treatment,left ventricular end-diastolic diameter,left ventricular ejection fraction and NT-prob NP were improved,and there was no difference between the two groups(P > 0.05).(3)Secondary indicators: before treatment,serum creatinine,blood urea nitrogen and SOFA scores in hf group were higher than those in non HF group(P < 0.05);After treatment,serum creatinine,blood urea nitrogen and SOFA scores were improved and there was no difference between the two groups(P > 0.05).Conclusions:1.CRRT slowly and continuously removes excess water and solutes from the body through the principles of diffusion,convection and ultrafiltration,which can not only improve the kidney function of patients,but also accurately and effectively manage the patient’s volume.In particular,it has little influence on circulation and keeps the hemodynamics of severe patients relatively stable.2.CRRT can slowly and smoothly remove excess water in the body,reduce volume load,improve volume reactivity of patients with heart failure,increase tissue perfusion and improve cardiac function.3.SOFA score of patients decreased significantly after CRRT treatment,suggesting that the disease can be alleviated and may be beneficial to the prognosis of patients with AKI.