Analysis Of The Application Effect Of CRRT In The Treatment Of Critical Burn

Objective To analyze the clinical data before and after continuous renal replacement therapy(CRRT)in critical burn patients,and to discuss the effect of CRRT in critical burn patients and its impact on prognosis,so as to provide a reference for the treatment of critical burn patients.Methods Patients with critical burns who were seen in the care unit of the burn plastic and aesthetic department of the General Hospital of Ningxia Medical University and treated with CRRT from January 2015 to December 2021 were used in this study,and all cases met the inclusion and exclusion criteria,with a total of 66 cases.Patients’ gender,age,cause of burn,burn area,APACHE II score,CRRT mode,number of CRRT treatments,CRRT duration,and physiological indexes(mean arterial pressure,heart rate,respiratory rate,etc.)and test results(white blood cells,hemoglobin,platelets,potassium,sodium,creatinine,urea,p H,lactate,partial pressure of oxygen,coagulation(leukocytes,hemoglobin,platelets,potassium,sodium,creatinine,urea,p H,lactate,partial pressure of oxygen,coagulation,CRP,PCT,IL-6).Specifics: 1.To compare the clinical data of patients in the survivor group with those in the non-survivor group and analyze the risk factors associated with death in critical burn patients treated with CRRT,to select the statistically significant indicators in the univariate analysis,to include the binomial logistic regression analysis,and also to draw the ROC curve,to calculate the area under the curve,and to assess the predictive value of each factor on the mortality of patients;to compare the clinical data of patients in the two groups treated with CRRT The clinical data before,12 h,24h,48 h and after the end of CRRT treatment to analyze the effect of CRRT application.2.According to the time of CRRT initiation after burn injury,the study subjects were divided into early burn injury CRRT group and late burn injury CRRT group,and the clinical data of patients in the two groups before CRRT treatment were compared,and the Kaplan-Meier survival analysis method was used to plot survival curves and analyze the influence of the time of CRRT initiation after burn injury on patients’ prognosis.3.Before CRRT treatment,the study subjects were divided into the early acute kidney injury(AKI)group and the late AKI group according to the KDIGO AKI consultation guidelines,and the clinical data of the two groups were compared,and the survival curves of the two groups were plotted to analyze the effect of the severity of AKI at the beginning of CRRT on patient mortality.Results1.Of the 66 patients enrolled,37 were in the survival group and 29 in the death group(43.94%);there were no significant differences in age,total burn area and mean arterial pressure at admission,respiratory rate,heart rate,white blood cell count,hemoglobin,renal function,coagulation-related indexes,oxygenation index,PCT,and IL-6 between the survival and non-survival groups;the non-survival group had significantly higher third-degree burn area,ABSI and APACHE II score and arterial blood lactate results were significantly higher in the non-survival group than in the survival group,and the length of stay in the guardianship unit was greater than that in the survival group,with statistically significant differences(P <0.05);there were no significant differences in the time of CRRT initiation,total time of CRRT treatment,and number of treatments between the two groups.2.At the end of CRRT treatment,the results of leukocyte count,creatinine,urea,lactate,CRP,and IL-6 decreased in the surviving and non-surviving groups compared with those before treatment(P < 0.05).3.The results of the binomial logistic regression analysis showed that APACHE II score(OR 4.43,95% CI 1.57-12.43),ABSI(OR 2.82,95% CI 1.09-7.25)were independent risk factors for mortality in critical burn patients;third-degree burn area,and CRP were not statistically significant(P > 0.05).4.The ROC curve showed the highest predictive efficacy of APACHE II score for death,corresponding to an AUC value of 0.972 and a Cut-off value of 20.5.Survival analysis results: Log-rank test analysis showed no significant difference in survival rates after CRRT treatment between the early burn group and the late group;there was no statistically significant difference in survival curves between the group starting CRRT treatment early in AKI and the late group(P > 0.05).Conclusion1.Third-degree burn area,ABSI,APACHE II score,lactate,CRP as risk factors for mortality in critical burn patients,among which APACHE II score and ABSI are independent risk factors,and the larger the APACHE II score,the higher the mortality rate of the patient.2.CRRT can remove inflammatory mediators,maintain acid-base balance,and improve organ function.3.The present The results of the study do not yet prove that the timing of CRRT initiation has an effect on the prognosis of critical burn patients.4.The severity of AKI at the start of CRRT is not related to disease regression in critical burn patients.