脓毒症患者连续性肾替代治疗时机选择及预后比较  

Comparison of timing and prognosis of continuous renal replacement therapy in patients with sepsis

作　　者：郭剑[1] 雷洁洁 章柏平[1] 吴辉[1] 

机构地区：[1]解放军第184医院急诊与重症医学科,鹰潭335000

出　　处：《东南国防医药》2018年第1期37-40,共4页Military Medical Journal of Southeast China

摘　　要：目的对比脓毒症患者连续性肾替代治疗时机选择及预后情况。方法回顾性分析解放军第184医院行血液滤过治疗的脓毒症210例患者,其中112例治疗前急性生理学与慢性健康状况评分II(APACHEⅡ)评分<25分者为低APACHEⅡ评分组,98例APACHEⅡ评分≥25分者为高APACHEⅡ评分组,对比2组治疗前后各生化及生理指标的情况。结果治疗后2组心率、动脉血氧分压、白细胞、尿素氮、血肌酐及血小板计数等均优于治疗前(P<0.05),且低APACHEⅡ评分组心率、血小板计数、尿素氮、血肌酐等均优于高APACHEⅡ评分组(P<0.05)。休克、血液滤过开始时间、APACHEⅡ评分是影响患者预后的独立危险因素(P<0.05)。结论连续性肾替代治疗可有效改善脓毒症患者各生化及生理指标,有助于改善其病情转归情况。休克、血液滤过开始时间、APACHEⅡ评分是影响脓毒症患者预后的独立危险因素,早期对APACHEⅡ评分较低的患者进行血液滤过治疗能够明显改善其疗效,改善患者预后情况。Objective To compare the timing and prognosis of continuous renal replacement therapy in patients with sepsis.Methods Retrospectively analysis of 210 patients with sepsis receiving hemofiltration treatment was conducted in our hospital. 112 cases whose acute physiology and chronic health evaluation II score （APACHE II）〈25 points before treatment was regarded as the low APACHE II score group, and those of APACHE II scores ≥25 points as the high APACHE II score group. The biochemical and physiological indexes before and after treatment were compared between the two groups.Results After treatment, the levels of heart rate, arterial partial pressure of oxygen, white blood cells, blood urea nitrogen, serum creatinine, blood platelet, and others of the two groups were better than those before treatment （P〈0.05）.The heart rate, blood platelet, blood urea nitrogen, serum creatinine of the low APACHE II score group were better than those in the high APACHE II score group （P〈0.05）. Shock, starting time of hemofiltration and APACHE II score were independent risk factors on prognosis （P〈0.05）.Conclusion Continuous renal replacement therapy can effectively improve the biochemical and physiological indexes of patients with sepsis, which can help to improve their prognosis. Shock, starting time of hemofiltration and APACHE II score are independent risk factors on prognosis in patients with sepsis. Early hemofiltration treatment on patients with lower APACHE II scores can significantly improve their curative effects and prognosis.

关 键 词：脓毒症 血液滤过 连续性肾替代疗法 治疗时机 

分 类 号：R459.7[医药卫生—急诊医学]