Clinical study on continuous renal replacement therapy in neonatal sepsis-related acute kidney injury
Objective To investigate the application value of continuous renal replacement therapy(CRRT)in the treatment of neonatal sepsis-associated acute kidney injury(AKI).Methods A total of 26 neonates with sepsis-associated AKI diagnosed and treated from June 2017 to August 2021 were selected for retrospective analysis.All of them were given CRRT;observe the duration of CRRT treatment,length of hospital stay,complications and 28 d survival rate.The following indexes before treatment,at 12 h,24 h and 48 h after treatment as well as at the end of the treatment were also recorded:mean arterial pressure(MAP),pH value,oxygenation index,lactic acid,serum creatinine(Scr),blood urea nitrogen(BUN),cystatin C(CysC),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),Toll-like receptor 4(TLR4),and neutrophil gelatinase-associated lipocalin(NGAL).The one-way repeated measures ANOVA was used to analyze the changes in the clinical indexes at different treatment time.Results Continuous renal replacement was successfully completed in 26 neonates with sepsis-associated AKI,with a survival rate of 88.46％(23/26)at 28 days.The duration of CRRT treatment was(73.52±12.65)h and the duration of hospitalization was(10.25±2.32)d.MAP,oxygenation index,and pH at 12 h,24 h,48 h and at the end of treatment were higher than those before treatment,and urine volume was more than before treatment,while lactic acid,Scr,BUN,CysC,TNF-α,IL-6,TLR4 and NGAL were all lower than before treatment,and the differences were statistically significant(P＜0.05).There were 4 cases of hypotension(15.38％),3 cases of hypothermia(11.54％)and 3 cases of catheter blockage(11.54％)during the treatment of CRRT.The 7 d NBNS score of 7 patients was less than 35 points,and 2 patients had abnormal Vojta postural reflex.Conclusion CRRT has ideal effects and is safe in the treatment of neonatal sepsis-related AKI,which can effectively reduce inflammatory factors,correct water and electrolyte disorders,and avoid further kidney damage,but there is a risk of long-term brain injury,and clinical attention should be paid to it.
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