【摘要】目的探讨重症急性胰腺炎(severe acute pancreatitis，SAP)合并急性肾损伤(acutekidney injury，AKI)时连续性肾替代治疗(continuous renal replacement therapy ，CRRT)开始时机。方法回顾性分析2010～2013 年合并AKI 的SAP 患者病例资料，根据KDIGO 的AKI1～3 期分级标准将患者分为开始CRRT 早(AKI1、2 期) 和开始晚(AKI 3 期)2 组，比较患者人口学特征，开始CRRT 时的临床数据，预后指标是60 天ICU 住院病死率和ICU 住院时间。结果84 例合格患者纳入分析，早期开始CRRT 组27 例，晚期CRRT 组57 例。早晚2 组的60 天ICU 住院病死率分别为为30%(9/27)和59.3%(32/57)，差异具有统计学意义(c2=6.608，P =0.010)；并且开始早的患者的ICU 住院时间更短[HR:0.392(95% CI: 0.169～0.776)，P =0.009]。结论合并AKI 的SAP 患者的CRRT 宜在AKI早期(1 和2 期)开始。

【Abstract】Objective To explore the initiation time of continuous renal replacement therapy (CRRT) for severe acute pancreatitis (SAP) patients complicated with acute kidney injury (AKI). Methods SAP patients with AKI admitted to West China Hospital of Sichuan University and received CRRT during the period
from Jan. 2010 to Dec. 2013 were retrospectively analyzed. They were divided into early CRRT group (initiated at AKI stage 1 or 2) and late CRRT group (initiated at AKI stage 3). Demographic information and clinical data at the initiation of CRRT, and prognosis including the 60～day-ICU mortality and the retained days in ICU were compared between the two groups. Results A total of 84 patients were analyzed, 30 patients in the early CRRT group and 57 patients in the late CRRT group. The 60-day-ICU mortality was 30% (9/27) in the early CRRT group and was 59.3% (32/57) in the late CRRT group (c2=6.608, P=0.010). The retained days in ICU was shorter in the early CRRT group than in the late CRRT group (HR=0.392, 95% CI: 0.169～0.776; P=0.009). Conclusion CRRT performed at the early stage (at AKI stage 1 or 2) may be optimal for the treatment of SAP patients complicated with AKI.