Efficacy of meropenem combined with continuous renal replacement therapy in the treatment of sepsis-associated acute kidney injury and its impact on renal function recovery

doi:10.3760/cma.j.cn441417-20241030-09020

Abstract

Abstract:

Objective　To investigate the efficacy of meropenem combined with continuous renal replacement therapy (CRRT) in the treatment of sepsis-associated acute kidney injury (S-AKI) and its impact on renal function recovery. Methods　A total of 60 patients with S-AKI admitted to Heilongjiang Provincial Hospital from June 2023 to May 2024 were selected as the study subjects. Using a random number table, patients were divided into an observation group and a control group, with 30 patients in each group. There were 12 males and 18 females in the control group, aged (38.50±2.75) years, acute kidney injury staging: stage Ⅰ (17 cases), stage Ⅱ (7 cases), and stage Ⅲ (6 cases). There were 14 males and 16 females in the observation group, aged (38.17±2.63) years, acute kidney injury staging: stage Ⅰ (15 cases), stage Ⅱ (8 cases), and stage Ⅲ (7 cases). The control group received CRRT, while the observation group received meropenem combined with CRRT. Therapeutic outcomes [intensive care unit (ICU) stay duration, urine output recovery time, and cardiovascular events], survival rates; infectious indicators [white blood cell count (WBC), neutrophil ratio (NEUR), and procalcitonin (PCT)], inflammatory factors [interleukin (IL)-6, IL-1β, and tumor necrosis factor-α (TNF-α)], and renal function indicators [blood urea nitrogen (BUN), urinary protein, and creatinine] were compared before and 3 d after treatment. Independent sample t test, paired t test, and χ² test were used for statistical analysis. Results　The ICU hospitalization time and the time for urine output recovery in the observation group were shorter than those in the control group [(8.67±1.49) d vs. (12.23±3.67) d, (7.63±4.48) d vs. (11.27±8.28) d], and the total incidence rate of cardiovascular events was lower than that of the control group [13.33% (4/30) vs. 40.00% (12/30)] (all P<0.05). After 3 d of treatment, the levels of WBC, NEUR and PCT in the observation group were lower than those in the control group [(8.91±3.08)×10⁹/L vs. (11.57±5.59)×10⁹/L, (71.10±2.30)% vs. (76.54±3.13)%, (0.39±0.09) μg/L vs. (0.45±0.09) μg/L] (all P<0.05); the levels of IL-6, IL-1β and TNF-α in the observation group were lower than those in the control group [(87.58±9.07) ng/L vs. (185.32±23.23) ng/L, (14.58±3.26) μg/L vs. (24.06±3.61) μg/L, (45.37±8.29) ng/L vs. (74.09±9.27) ng/L] (all P<0.05); the levels of BUN, urine protein and creatinine in the observation group were lower than those in the control group [(7.12±0.93) mmol/L vs. (9.71±1.13) mmol/L, (6.18±1.18) mg/24 h vs. (10.97±2.35) mg/24 h, (49.51±2.18) μmol/L vs. (57.05±5.28) μmol/L] (all P<0.05). After 28 d of follow-up, the survival rate in the observation group was higher than that in the control group [93.33% (28/30) vs. 73.33% (22/30)] (P<0.05). Conclusion　Meropenem combined with CRRT can reduce ICU stay duration, urine output recovery time, and the incidence of cardiovascular events in patients with S-AKI. It also lowers infectious indicators and inflammatory factor levels, aids in renal function recovery, and improves survival rates.

Key words: Sepsis-associated acute kidney injury, , Meropenem, , Continuous renal replacement therapy, , Therapeutic efficacy, , Renal function

摘要： 目的　探究美罗培南联合连续性肾脏替代治疗（CRRT）脓毒症急性肾损伤（S-AKI）的效果及对肾功能恢复的影响。方法　选取2023年6月至2024年5月黑龙江省医院收治的60例S-AKI患者作为研究对象。采用随机数字表法，将患者分为观察组与对照组，各30例。对照组男12例，女18例；年龄（38.50±2.75）岁；急性肾损伤分期：Ⅰ期17例，Ⅱ期7例，Ⅲ期6例。观察组男14例，女16例；年龄（38.17±2.63）岁；急性肾损伤分期：Ⅰ期15例，Ⅱ期8例，Ⅲ期7例。对照组采用CRRT，观察组采用美罗培南联合CRRT。比较两组治疗效果［重症监护病房（ICU）住院时间、尿量恢复时间及心血管事件］、生存情况；治疗前和治疗3 d后感染性指标［白细胞计数（WBC）、中性粒细胞比率（NEUR）及降钙素原（PCT）］、炎症因子［白细胞介素（IL）-6、IL-1β及肿瘤坏死因子-α（TNF-α）］和肾功能［血尿素氮（BUN）、尿蛋白及肌酐］。采用独立样本t检验、配对t检验和χ2检验进行统计学分析。结果　观察组ICU住院时间、尿量恢复时间均短于对照组［（8.67±1.49）d比（12.23±3.67）d、（7.63±4.48）d比（11.27±8.28）d］，心血管事件总发生率低于对照组［13.33%（4/30）比40.00%（12/30）］（均P<0.05）。治疗3 d后，观察组WBC、NEUR及PCT水平均低于对照组［（8.91±3.08）×109/L比（11.57±5.59）×109/L、（71.10±2.30）%比（76.54±3.13）%、（0.39±0.09）μg/L比（0.45±0.09）μg/L］（均P<0.05）；观察组IL-6、IL-1β及TNF-α水平均低于对照组［（87.58±9.07）ng/L比（185.32±23.23）ng/L、（14.58±3.26）μg/L比（24.06±3.61）μg/L、（45.37±8.29）ng/L比（74.09±9.27）ng/L］（均P<0.05）；观察组BUN、尿蛋白及肌酐水平均低于对照组［（7.12±0.93）mmol/L比（9.71±1.13）mmol/L、（6.18±1.18）mg/24 h比（10.97±2.35）mg/24 h、（49.51±2.18）μmol/L比（57.05±5.28）μmol/L］（均P<0.05）。随访28 d后，观察组存活率高于对照组［93.33%（28/30）比73.33%（22/30）］（P<0.05）。结论　美罗培南联合CRRT可减少S-AKI患者ICU住院时间、尿量恢复时间，降低心血管事件发生率和感染性指标、炎症因子水平，有助于肾功能恢复，提高存活率。

关键词: 脓毒症急性肾损伤, 美罗培南, 连续性肾脏替代治疗, 疗效, 肾功能

Hao Xin, Guo Wei, Tan Dandan, Guo Jinyan, Ma Ning, Lan Yuhuai.

Efficacy of meropenem combined with continuous renal replacement therapy in the treatment of sepsis-associated acute kidney injury and its impact on renal function recovery [J]. International Medicine and Health Guidance News, 2025, 31(9): 1511-1515.

郝鑫郭威谭丹丹郭金燕马宁兰玉怀.

美罗培南联合连续性肾脏替代治疗脓毒症急性肾损伤的效果及对肾功能恢复的影响 [J]. 国际医药卫生导报, 2025, 31(9): 1511-1515.

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