连续肾脏替代治疗在多脏器功能不全患者中的疗效观察  

Therapeutic effects of continuous renal replacement in patients with multiple organ dysfunction syndrome in ICU

作　　者：刘双庆[1] 郭剑颖[1] 鲍珍[1] 翁志华[1] 张玉红[1] 何忠杰[1] 

机构地区：[1]解放军总医院第一附属医院重症医学科,北京100037

出　　处：《解放军医学杂志》2013年第5期383-386,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的观察连续肾脏替代治疗(CRRT)在不同病因所致多脏器功能不全(MODS)患者中的应用效果。方法纳入2011年9月-2012年9月在解放军总医院第一附属医院重症医学科治疗期间发生的MODS患者47例,根据发病原因分为脓毒症组(n=28)和非脓毒症组(n=19)。分别在CRRT开始前即刻和CRRT治疗后12h采集患者的全身血流动力学指标、脑部血流动力学指标、氧合指标及代谢指标。根据每组患者的APACHEⅡ评分计算预期病死率,通过与实际病死率比较得到标准化病死率(SMR),规定SMR<0.9为生存率改善。结果经12h CRRT后,脓毒症组患者的临床及实验室指标大部分得到明显改善(平均动脉压和脑部血流动力学指标除外),最终存活出院17例,SMR为0.70;非脓毒症组患者仅3例存活出院,SMR为1.77,观察指标中仅吸入氧浓度得到明显改善。结论 CRRT可显著改善由脓毒症引发的MODS患者的临床指标及生存率,而在非脓毒症为基础因素引发的MODS患者中,未观察到显著疗效。Objective To investigate the effects of continuous renal replacement therapy （CRRT） on patients with multiple organ dysfunction syndrome （MODS）. Methods Forty-seven patients with MODS, admitted to the Department of SICU of First Affiliated Hospital of General Hospital of PLA, were divided into two groups according to the causative agents： the sepsis group （n--28） and the non-sepsis group （n=19）. All the patients involved were treated with CRRT therapy. The systemic and brain hemodynamic parameters, and oxygenation and metabolic variables were assessed immediately before and 12 hours after CRRT. The expected mortality was obtained by APACHE Ⅱ score, and it was compared with the actual mortality to obtain the standard mortality, of which less than 0.9 was defined as an improved survival rate. Results After 12 hours of CRRT treatment, all the variables （except mean arterial pressure and brain hemodynamics） were significantly improved in the sepsis group （P〈0.05）. The survival rate in ICU was 60.7% with a standard mortality of 0.70. In the non-sepsis group, the survival rate in ICU was only 15.8% and the standard mortality was 1.77. Only the FiO2 was found to be significantly improved in the non-sepsis group. Conclusion CRRT may significantly improve the clinical outcome and survival rate of patients with sepsis-caused MODS, but no obvious effect is found among the patients with MODS caused by non-sepsis factors.

关 键 词：肾替代疗法 脓毒症 多器官功能衰竭 病死率 

分 类 号：R631.2[医药卫生—外科学]