RIFLE标准在高容量血液滤过治疗MODS患者疗效的评价  

Using RIFLE Criteria to Evaluate the Therapy Effect of High-volume Hemofiltration for Patients with MODS

作　　者：蒋利[1] 陈雪[1] 张立平[1] 殷秀梅[1] 刘顺碧[1] 唐秀英[1] 张渝华[1] 丁盛[1] 

机构地区：[1]成都军区总医院重症医学科,四川成都610083

出　　处：《现代生物医学进展》2011年第16期3098-3101,共4页Progress in Modern Biomedicine

基　　金：四川省卫生厅计划项目(No.100189);四川省卫生厅资助项目(No.100095;100190)

摘　　要：目的:探讨不同肾功能损害时期行高容量血液滤过(HVHF)治疗对多器官功能障碍综合征(MODS)疗效的影响。方法:采用RIFLE标准,将入选的MODS患者按急性肾损伤(AKI)分为AKIⅠ期(A组)、AKIⅡ期(B组)、AKIⅢ期(C组),以不同AKI分期作为HVHF治疗的时机,对比分析不同时期行HVHF治疗MODS患者的死亡率、平均重症监护病房(JCU)院时间(T1)、平均机械通气时间(T2)、平均连续血液滤过治疗时间(T3),并将HVHF治疗前和治疗24h后的APACHEⅡ评分、SOFA评分、血浆白介素-6(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:1、AKIⅢ期患者死亡率显著高于AKⅡ期和AKIⅡ期患者(P<0.01);AKIⅡ期患者T1、T2和T3显著高于AKIⅠ期患者(P<0.01);2、与AKIⅠ期和AKIⅡ期患者比较,AKIⅢ期患者HVHF治疗前APACHEⅡ评分、SOFA评分、IL-6和Cr均显著增高(P<0.05);AKIⅡ期患者HVHF治疗前血浆IL-6显著高于AKIⅠ期患者(P<0.01);3、与HVHF治疗前比较,三组患者HVHF治疗24 h后IL-6、氧合指数、Cr和MAP均显著改善(P<0.01);AKIⅢ期患者治疗后的IL-6仍显著高于AKIⅠ期和AKIⅡ期患者;AKIⅠ期和AKIⅡ期患者HVHF治疗24h后APACHEⅡ评分、SOFA评分显著降低(P<0.01),AKIⅢ期患者治疗前后APACHEⅡ评分和SOFA评分变化无显著统计学差异。结论:RIFLE标准及IL-6对判断预后有指导意义;AKIⅠ期和Ⅱ期行HVHF可明显改善MODS的预后,而AKI I期行HVHF的疗效更好。Objective： To investigate the prognosis of patients with multiple organ dysfunction syndrome （MODS）using high-volume hemofiltration （HVHF） for different timing weighting by RIFLE criteria. Methods： All the cases were divided into three groups according to the RIFLE criteria： Stage AKI Ⅰ （group A）, Stage AKI Ⅱ （group B）, Stage AKI Ⅲ （group C）. The mortality, ICU length of stay（T1）, duration of total mechanical ventilation（T2） and the length of HVHF（T3） were compared among three groups. Their APACHE Ⅱ score, sequential organ failure assessment（SOFA） score, serum interleukin-6（IL-6）, oxygenate index,serum ereatinine, mean arterial pressure （MAP） were compared before and after HVHF for 24 hours. Results： 1. The mortality of Stage AKI Ⅲ patients was higher than that of Stage AKI Ⅰ and Ⅱ patients （P〈0.01）; T1,T2 and T3 of Stage AKI Ⅱ patients was higher than those of Stage AKI Ⅰ patients （P〈0.01）. 2. Befor HVHF, APACHE Ⅱ score, SOFA score, IL-6 and Cr were higher in Stage AKI HI patients than those with Stage AKI Ⅰ and Ⅱ （P〈0.05）. 3. Compare with pre-treatment of HVHF, IL-6, oxygenate index, serum creatinine and MAP improved significantly in all patients after HVHF for 24 hours, IL-6 in Stage AKI Ⅲ patients was still higher than that of Stage AKI Ⅰ and Ⅱ patients; APACHE Ⅱ score and SOFA score decreased significantly in Stage AKI Ⅰ and Ⅱ patients. Conclusions： RIFLE criteria and IL-6 are useful for the prognosis prediction. HVHF remarkably improves the prognosis of patients with Stage AKI Ⅰ and Ⅱ .Therapeutic effect of patients with MODS is better when HVHF started in the Stage AKI Ⅰ.

关 键 词：血液滤过 多器官功能障碍综合征 急性肾损伤 RIFLE标准 

分 类 号：R459.7[医药卫生—急诊医学] R459.5[医药卫生—治疗学]