连续性血液净化治疗合并急性肾损伤的多器官功能障碍综合征临床价值及预后影响因素分析  

Clinical Value and Prognostic Influencing Factors of Continuous Blood Purification in Treatment of Patients with Acute Kidney Injury Combined with Multiple Organ Dysfunction Syndrome

作　　者：王翔 宋亚君[2] 吕明珠 张志敏[1] 苗丽霞[1] WANG Xiang;SONG Ya-jun;LYU Ming-zhu;ZHANG Zhi-min;MIAO Li-xia(Department of ICU,Dongfeng General Hospital Affiliated to Hubei Medical College, Shiyan, Hubei 442000, China;Department of Clinical Laboratory,Dongfeng General Hospital Affiliated to Hubei Medical College, Shiyan, Hubei 442000, China;Department of Paediatrics, Dongfeng General Hospital Affiliated to Hubei Medical College, Shiyan, Hubei 442000, China)

机构地区：[1]湖北医药学院附属东风总医院重症医学科,湖北十堰442000 [2]湖北医药学院附属东风总医院检验科,湖北十堰442000 [3]湖北医药学院附属东风总医院儿科,湖北十堰442000

出　　处：《解放军医药杂志》2019年第4期60-63,77,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：湖北省自然科学基金资助项目(2014CDB07152)

摘　　要：目的探讨连续性血液净化(CBP)治疗合并急性肾损伤(AKI)的多器官功能障碍综合征(MODS)患者的临床价值及预后影响因素。方法选择2014年1月—2017年12月就诊治疗的68例合并AKI的MODS,记录患者一般资料,检测CBP治疗前后炎性因子、肝肾功能、血流动力学、急性生理学及慢性健康状况评分(APACHEⅡ评分)等指标和预后情况,并分析影响预后的危险因素。结果治疗后68例合并AKI的MODS患者C反应蛋白、白介素-6、肿瘤坏死因子-α、丙氨酸转氨酶、天冬氨酸转氨酶、总胆红素、直接胆红素、肌酐、尿素、心率、中心静脉压水平、APACHEⅡ评分及序贯性器官衰竭评分(SOFA)均较治疗前降低,而平均动脉压、心脏指数和氧和指数水平均升高(P <0. 01)。本组病死率为44. 12%。年龄≥60岁、AKIⅢ期、器官衰竭个数> 3个、采用机械通气及APACHEⅡ评分和SOFA评分过高均为影响合并AKI的MODS经CBP治疗后预后的独立危险因素(P <0. 05,P <0. 01)。结论 CBP治疗可显著降低合并AKI的MODS患者炎性因子水平,改善其肝肾功能和血流动力学,临床应及时评估预后情况,给予有效干预措施改善预后。Objective To investigate clinical value and prognostic influencing factors of continuous blood purification (CBP) in treatment of patients with acute kidney injury (AKI) combined with multiple organ dysfunction syndrome (MODS). Methods A total of 68 patients with MODS combined with AKI admitted during January 2014 and December 2017 were recruited in this study. General data of patients was recorded. Inflammatory factors, liver and kidney functions, hemodynamics, acute physiology and APACHE II score were detected before and after CBP treatment. Risk factors affecting prognosis were analyzed. Results After treatment, C-reactive protein, interleukin-6, tumor necrosis factor-α, alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, creatinine, urea, heart rate, central venous pressure levels and APACHE II and sequential organ failure assessment (SOFA) scores were significantly decreased, while levels of mean arterial pressure, cardiac index and oxygen index were significantly increased compared with those before treatment in 68 patients with MODS combined with AKI ( P <0.01). Mortality rate was 44.12%. Age equal or more than 60 years old, stage III AKI, numbers of organ failure more than 3 parts, mechanical ventilation, high scores of APACHE II and SOFA were independent risk factors affecting prognosis of patients with MODS combined with AKI after CBP treatment ( P <0.05, P <0.01). Conclusion CBP treatment may significantly reduce levels of inflammatory factors and improve liver and kidney functions and hemodynamics level in patients with MODS combined with AKI. Prognosis should be evaluated in time and effective intervention should be given to improve the prognosis.

关 键 词：急性肾损伤 多器官功能衰竭 连续性血液净化 预后 危险因素 

分 类 号：R365[医药卫生—病理学]