不同血液净化方法对脓毒症性急性肾损伤的预后影响  

Effects of different blood purification on the prognosis of patients with acute septic kirdney injury

作　　者：李家瑞[1] 由希雷[1] 武子霞[1] 王永明[1] 王浩[1] 王庆树 张红燕[1] 乔佑杰[1] 任新生[2] 

机构地区：[1]天津市天和医院急救医学科,天津300050 [2]天津市泰达医院ICU

出　　处：《中华急诊医学杂志》2009年第2期136-139,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨运用急性肾损伤（acute kidney injury，AKI）的RIFLE（Risk，Injury,Failure，Loss，and End-stage kidney disease）分层诊断标准和急性生理与慢性健康状况评分（APACHE）Ⅱ分析脓毒症性急性肾损伤采取不同血液净化方式对患者预后的影响。方法回顾性分析2004年3月至2006年9月收住于天津市天和医院ICU的96例脓毒症性急性肾损伤的患者；纳入标准：2001年国际脓毒症定义会议的诊断标准和2004年急性肾损伤的RIFLE分层诊断标准。依据血液净化方式分为持续性肾脏替代治疗（continuous renal replacement therapy，CRRT）组（54例）和间歇性血液透析（intermittent hemodialysis，IHD）组（42例），CRRT组参照RIFLE标准分为Ⅰ期、Ⅱ期、Ⅲ期；临床资料采用Excel建立数据库，SPSS11．5医学统计软件包进行数据分析，评价患者进入ICU即刻、48h、急性期末次血液净化结束后24h的生命体征、实验室指标、APACHEⅡ评分动态变化和患者的不同预后。两组资料的比较采用成组t检验，治疗前后的比较采用配对t检验，率的比较采用χ^2检验。结果①CRRT组与IHD组治疗前APACHEⅡ评分、血肌酐（Cr）差异无统计学意义（P〉0．05），病死率分别为51．9％和52．4％（P〉0．05），肾功能恢复率分别为92．3％与65．0％（P〈0．05）；②CRRT组患者平均动脉压（mean arterial pressure，MAP）和血氧饱和度（oxygen satutation，SpO2）较IHD组低（P〈0．05），治疗后MAP、SpO2有所上升（P〈0．05）；③CRRT组中Ⅰ期患者存活率78．6％、治疗前APACHEⅡ评分（25．4±2．5）、肾功能恢复率90．9％，APACHEⅡ变化（-13．6±4．3）；而Ⅲ期患者上诉指标分别为38．1％，（36．1±5．7），62．5％，（-7．1±4．2），差异具有统计学意义（P〈0．05）。结论RIFLE标准对AKI早期诊断和判断预后有指导意义，运用AKI的RIFLE标准结合APACHEⅡ评分选择治疗时机�Objective To evaluate the different methods of blood purification for acute septic renal injury （AKI） in respect of outcome by using RIFLE（risk, injury,failure, loss and end-stage renal disease）criteria and APACHE Ⅱ score. Method Data of 96 patients with ASRI admitted to ICU of Tianhe Hospital, Tianjin, from March 2004 to September 2006 were analyzed. Including criteria：2001 International Sepsis Definitions Conference and 2004 RIFLE criteria of AKI. The methods of blood purification used continuous renal replacement therapy （CRRT, n = 54） and intermittent hemodialysis （IHD, n = 42）. The patients of CRRT group could be. classified into stages Ⅰ , Ⅱ and Ⅲ referred to RIFLE criteria. Excel was evaluated to set up clinical data base from documented material. Data were analyzed with SPSS version 11.5 software. Physical signs, laboratory findings, variation of APACHE Ⅱ score and outcomes of patients were documented evaluated. Data of two groups compared using indepent samples T test, before and after the treatment compared using paired-samples T test, rate compared using chi-square test. Results （1）There were no statistical differences in APACHE Ⅱ score and creatinine （Cr） between CRRT group and IHD group before treatment （ P 〉 0.05）. The mortalities of CRRT group and IHD group were 51.9% and 52.4%, respectively （P 〉 0.05）, but the recovery rates of renal function in CRRT group and IHD group were 92.3 % and 65.0 %, respectively （ P 〈 0.05）. （2）Mean arterial pressure （MAP）, oxygen saturation （SpO2） of CRRT group were lower than those of IHD group （ P 〈 0.05） and they increased to some extent after treatment （ P 〈 0.05）. （3）In the patients of stag Ⅰ, the survival rate was 78.6%, APACHE Ⅱ score was 25.4 ± 2.5 before treatment, renal function recovery rate was 90.9%, and APACHE Ⅲ changed - 13.6 ± 4.3, while those relevant markers in the patients of stage Ⅲ were 38.1% ,36.1 ± 5.7,62.5% and - 7.1 ± 4.2, respectively （P 〈 0.05�

关 键 词：连续性肾脏替代治疗 间歇性血液透析 脓毒症 急性肾损伤 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]