持续性肾脏替代治疗在脓毒症诱发多脏器功能失常综合征患者中的应用价值  

Values of continuous renal replacement therapy in the treatment of multiple organ dysfunction syn-drome induced by sepsis

作　　者：何新飙[1] 赵伟[2] 闫素英[1] 

机构地区：[1]天津医科大学第二医院急救中心,天津300211 [2]天津医科大学公共卫生学院

出　　处：《中华急诊医学杂志》2011年第6期600-603,共4页Chinese Journal of Emergency Medicine

基　　金：天津市自然科学基金资助项目（09JCYBJCll300）;天津医科大学第二医院科研基金资助（y074）2）

摘　　要：目的探讨持续性肾脏替代治疗（continuous renal replacement therapy，CRRT）在脓毒症诱发多脏器功能失常综合征（multiple organ dysfunction syndrome，MODS）患者中的应用价值。方法天津医科大学第二医院院ICU的62例脓毒症导致MODS患者，按CRRT时间分为非CRRT组、短CRRT组（24-48h）和长CRRT组（〉48h）。观察各组脏器功能、血浆内皮素-1（ET．1）、脓毒症相关器官衰竭（SOFA）评分、生存时间和累计生存率的变化。结果其中长CRRT组的SOFA评分逐渐下降于第4天处于相对低值，与非CRRT组相比较，差异具有统计学意义（P〈0．05）；而短CRRT组的SOFA评分逐渐下降于第6天处于相对低值，与非CRRT组相比较差异具有统计学意义（P〈0．05）。非CRRT、短CRRT和长CRRT的3d生存率分别为56．3％、83．3％和88．9％，差异具有统计学意义（P〈0．05）；三组3周生存率分别为53．1％、58．3％和66．7％，差异无统计学意义（P〉0．05）。生存时间分别为非CRRT组（4．4±2．6）d，短CRRT组（9．5±6．1）d和长CRRT组（10．3±5．4）d，与非CRRT组相比，短CRRT组和长CRRT组患者的生存时间明显长于非CRRT组（P〈0．05）。患者血浆ET-1在CRRT治疗后明显下降（P〈0．05）。结论CRRT能有效改善MODS患者的脏器功能，适当地延长CRRT时间可以明显降低SOFA评分，提高患者短期生存率。Objective To study the values of continuous renal replacement therapy （CRRT） for the treatment of multiple organ dysfunction syndrome （MODS） induced by sepsis. Methods A total of 62 pa- tients with MODS were divided into three groups, namely non-CRRT group, short period CRRT group （24 - 48 h） and long period CRRT group （ 〉 48 h）. Relevant factors including organ function, plasma endothelin-1 （ET-1）, sepsis-related organ failure assessment（SOFA） score, average length of survival time and accumulative survival rate were analyzed . Results Compared with non-CRRT group, a statistically significant difference in SOFA score was evident on the 4th day after long period CRRT group and on the 6th day after short period CRRT group. The survival rates of three groups on the third day after treatment were 56.3%, 83.3% and 88.9%, respectively （P 〈 O. 05 ）. The survival rates of three groups three weeks after treatment were 53.1% , 58.3% and 66.7% , respectively （ P 〉 0.05 ）. The average lengths of survival time in three groups were（4.4 ±2.6） days, （9.5 ±6.1 ） days and （ 10.3 ±5.4 ） days, respectively. Compared with nonCRRT group, the average lengths of survival time were longer in the other two groups. The levels of serum ET-1 significantly decreased after CRRT treatment （P 〈 0.05 ）. Conclusions The organ function and sur- vival rate could be improved by CRRT. Average lengths of survival time were significantly prolonged in two CRRT groups（ P 〈 0.05 ）. More effective therapeutic results including lower SOFA score and longer average length of survival time were observed when the course of CRRT was extended longer properly.

关 键 词：脓毒症 持续性肾脏替代治疗 多脏器功能失常综合征 

分 类 号：R459.7[医药卫生—急诊医学]