关键词: 连续性肾脏替代治疗, 多发伤, 急性肾损伤, 多器官功能障碍综合征, 死亡率

Abstract: Background　Severe multiple trauma due to systemic inflammatory response syndrome，tissue damage，shock，and even the use of vascular active drugs lead to morbidity of acute kidney injury（AKI）is as high as 18%-26%，which influence with the prognosis of patients，and continuous renal replacement therapy（CRRT） is widely used as prevention and treatment of acute renal injury treatment，but at the moment of intervention time for severe multiple trauma patients complicated with acute kidney injury is still uncertain.Objective　To investigate the effect of continuous renal replacement therapy at different time on the prognosis of severe multiple trauma patients complicated with AKI.Methods　90 patients with severe multiple injuries complicated with AKI admitted to the department of critical care in the first affiliated hospital of chongqing medical university from May 2015 to May 2018 were selected as the research objects.all cases were divided into observation group and control group with using random sampling method，There were 45 cases in each group.The observation group were received 24h CRRT treatment during the RIFLE grading I stage after AKI，and the control group were received 24 h CRRT treatment during the RIFLE grading F stage after AKI.Sodium citrate or heparin-free treatment were given during CRRT 24 h.The general clinical data of the patients after admission，the surgical status and shock status of the patients before CRRT，the use of a large number of vasoactive drugs，the indicators related to systemic inflammatory response syndrome of the patients，and the prognostic indicators of the patients within 10 days after surgery were recorded.Results　Gender，age，serum creatinine，score of trauma severity，and cause of injury are not significantly different between the control group and the observation group（P>0.05）.There is no significant difference in the ratio of head/neck，face，chest，abdomen/pelvic cavity between the two groups（P>0.05），but there is significant difference in the ratio of limbs（P<0.05）.There are no statistically significant difference between the two groups in preoperative CRRT surgery，shock and use of a large number of vasoactive drugs（P>0.05）.There were no statistically significant differences in body temperature，systolic blood pressure，respiratory frequency，pulse，PCO2 and white blood cell count between the two groups before and after treatment（P>0.05）.There were no statistically significant differences in body temperature and systolic blood pressure between the two groups before and after treatment（P>0.05）.there are statistically significant difference in the respiratory frequency，pulse，PCO2 and white blood cell count of the two groups before and after treatment were compared.（P<0.05）.compared to control group，there are statistically significant difference in indexes of patients had complete recovery of renal function underwent CRRT again，developed multiple organ dysfunction syndrome，and died of multi-organ dysfunction syndrome within 10 days inobserve group.（P<0.05）.Conclusion　The patients with severe multiple trauma complicate with AKI were treated with CRRT earlier can effectively promote renal function recovery，prevent MODS and improve prognosis.

Key words: Continuous renal replacement therapy, Multiple trauma, AKI, Multiple organ dysfunction syndromes, Mortality