RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究  

Application of RIFLE criteria in the treatment of high-volume hemofiltration for patients with severe trauma complicated with multiple organ dysfunction syndrome

作　　者：姜建青[1] 刘宝玉[1] 俞永康[1] 郑轶峰[1] 李卫[1] 刘小燕[1] 尹昌林[2] 张渝华[3] 

机构地区：[1]成都军区总医院胸外科,成都610083 [2]第三军医大学西南医院急救部,重庆400038 [3]成都军区总医院重症医学科,成都610083

出　　处：《重庆医科大学学报》2011年第4期479-482,共4页Journal of Chongqing Medical University

基　　金：四川省卫生厅资助项目(编号:100095;100189;100190)

摘　　要：目的:探讨以RIFLE标准衡量高容量血液滤过(High-volume hemofiltration,HVHF)治疗严重创伤并发多器官功能障碍综合征(Multiple organ dysfunction syndrome,MODS)的治疗时机及其对预后的影响。方法:回顾性分析成都军区总医院和西南医院自2006年以来行HVHF治疗的47例严重创伤并发MODS的患者,采用RIFLE标准,分A组(AKIⅠ期)、B组(AKIⅡ期)、C组(AKIⅢ期),以AKI分期作为HVHF治疗的时机,对比分析各组的死亡率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间,并将HVHF治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血浆IL-6、氧合指数、血浆肌酐(Cr)、平均动脉压(MAP)等结果进行比较。结果:①C组HVHF治疗前APACHEⅡ评分、SOFA评分、血浆IL-6及死亡率均明显高于A、B 2组(P<0.01);②A、B 2组HVHF治疗前APACHEⅡ评分、SOFA评分及死亡率差异无统计学意义,但B组HVHF治疗前IL-6浓度以及平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间明显高于或长于A组(P<0.01);③3组HVHF治疗24 h后血浆IL-6、氧合指数、Cr、MAP均明显改善,但C组IL-6仍高于A、B 2组(P<0.01),B组IL-6仍高于A组(P<0.01);A、B 2组HVHF治疗24 h后APACHEⅡ评分、SOFA评分显著降低(P<0.01),C组变化无显著性。结论:HVHF能有效辅助治疗严重创伤并发MODS;RIFLE标准及IL-6对判断预后有指导意义;早期(AKIⅠ期和Ⅱ期)行HVHF可明显改善严重创伤并发MODS的预后,而AKIⅠ期行HVHF的疗效更好。Objective： To investigate the prognosis of patients with severe trauma complicated with multiple organ dysfunction syndrome （ MODS ） using high-volume hemofihration （HVHF）stratified with RIFLE criteria. Methods：We retrospective studied 47 patients with severe trauma complicated with MODS from Chengdu Military General Hospital and Southwest Hospital. These patients were treated with HVHF in the period of Jan. 2006 to Dec. 2010. All of them were divided into three groups：group A （AKI I ）, group B （AKI Ⅱ ）, and group C （ AKI Ⅲ ） according to the RIFLE criteria.The timing at which they received HVHF was analyzed by different phase of AKI. The mortality rate during hospital ization,length of ICU stay, duration of total mechanical ventilation, and the length of HVHF were compared among three groups. Their APACHE Ⅱ score, sequential organ failure assessment （ SOFA ） score, serum interleukin-6 （ IL-6 ） , oxy- genate index, serum creatinine, mean arterial pressure （ MAP ）were also compared before and 24 hours after HVHF. Results：①Before HVHF, APACHE Ⅱ score, SOFA score, serum IL-6, and the mortality rate were higher in patients with AKI of phase 111 than those with AKI of phase I and II （P 〈 0.01 ）.②Before HVHF, APACHE H score, SOFA score, and the mortality rate in patients with AKI of phase I and Ⅱ were insignificant（P 〉 0.05 ）, but serum IL-6 before HVHF and ICU length of stay, duration of total mechanical ventilation, the length of HVHF in patients with AKI of phase Ⅱ were higher or longer than those with AKI of phase I （P 〈 0.01 ）. ③24 hours afterHVHF, serum IL-6,oxygenate index, serum creatinine and MAP improved significantly in all patients （P 〈 0.01 ）,but serum IL-6 in patients with AKI of phase m was still higher than those with AKI of phase I and II , serum IL-6 in patients with AKI of phase II was still higher than those with AKI of phase I. APACHElI score and SOFA score decreased significandy in patients with AKI of phase I and II

关 键 词：高容量血液滤过 创伤 多器官功能障碍综合征 RIFLE标准 细胞因子 

分 类 号：R642[医药卫生—外科学] R655[医药卫生—临床医学]