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

摘要： 背景　严重多发伤患者由于全身炎症反应综合征、组织损伤、休克、血管活性药物的使用等导致急性肾损伤（AKI）发病率高达18%~26%，严重影响患者预后。连续性肾脏替代治疗（CRRT）作为防治AKI的主要治疗方式在临床上广泛使用，但目前对于严重多发伤合并AKI患者的最佳治疗时机尚未确定。目的　探讨不同时机进行CRRT对严重多发伤合并AKI患者预后的影响。方法　采用随机抽样方法，选取2015年5月—2018年5月重庆医科大学附属第一医院重症医学科收治的90例严重多发伤合并AKI患者作为研究对象。按随机数字表法将研究对象分为观察组和对照组，各45例。观察组在AKI后RIFLE分级I期进行24 h CRRT，对照组在AKI后RIFLE分级F期进行CRRT，在CRRT 24 h 期间均给予枸橼酸钠抗凝或无肝素治疗。记录患者入院后一般临床资料，CRRT前患者的手术情况、休克情况和大量血管活性药物使用情况，患者CRRT的全身炎症反应综合征相关指标，以及患者术后10 d内的预后效果指标。结果　对照组与观察组的性别、年龄、血清肌酐、创伤严重程度评分、致伤病因及致伤部位在头/颈、面、胸、腹/盆腔的比例比较，差异均无统计学意义（P>0.05）；两组患者致伤部位在四肢的比例比较，差异有统计学意义（P<0.05）。两组患者CRRT前手术情况、休克情况和大量血管活性药物使用情况比较，差异均无统计学意义（P>0.05）。两组患者治疗前后体温、收缩压、呼吸频率、脉搏、二氧化碳分压、白细胞计数组内比较，差异均无统计学意义（P>0.05）。治疗前及治疗后两组患者体温、收缩压比较，差异均无统计学意义（P>0.05）；治疗前及治疗后两组患者呼吸频率、脉搏、二氧化碳分压、白细胞计数比较，差异均有统计学意义（P<0.05）。两组患者10 d内肾功能完全恢复、再次行CRRT、发生多器官功能障碍综合征、多器官功能障碍综合征死亡情况比较，差异均有统计学意义（P<0.05）。结论　严重多发伤合并AKI早期进行CRRT，能有效促进患者肾功能恢复，防止多器官功能障碍综合征，改善预后。

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