连续性肾脏替代疗法治疗多器官功能障碍综合的疗效  

Overall efficacy of continuous renal replacement therapy in patients with multiple organ dysfunction syndrome without renal damage

作　　者：余凯[1] 周天恩[1] 王鹏飞[1] 蒋龙元[1] Yu Kai;Zhou Tianen;Wang Pengfei;Jiang Longyuan(Department of Emergency,the Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院急诊科

出　　处：《中华卫生应急电子杂志》2019年第5期262-266,共5页Chinese Journal of Hygiene Rescue(Electronic Edition)

摘　　要：目的探讨无肾损害的多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者行连续性肾脏替代疗法(continuous renal replacement therapy,CRRT)的疗效。方法回顾性分析中山大学孙逸仙纪念医院急诊科2012年3月30日至2018年2月1日收治的190例MODS患者,其中男性113例,女性77例;年龄14~97岁,平均(61.8)岁。将190例MODS患者分为两组,87例(其中29例患者无肾损伤)采用包括病因治疗、抗炎、器官功能支持等措施的常规治疗,未选择连续性肾脏替代疗法治疗(常规治疗组),103例(其中20例患者无肾损伤)除常规治疗外加用连续性肾脏替代疗法(CRRT组)。比较两组患者治疗24 h前后Marshall评分、急性生理功能和慢性健康状况评分系统Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分、序贯器官衰竭(Sequential Organ Failure Assessment,SOFA)评分及两组患者28 d生存率。再比较这两组患者中无肾损伤(肌酐正常)的两个亚组治疗24 h前后Marshall评分、APACHEⅡ评分、SOFA评分及28 d生存率评价CRRT的疗效。结果CRRT组治疗前后Marshall评分(7.3±2.6)分&(6.8±2.8)分、APACHEⅡ评分(24.1±7.8)分&(19.8±7.5)分及SOFA评分(11.8±2.6)分&(10.7±3.1)分均明显下降(P均<0.05),而常规治疗组治疗前后Marshall评分(7.0±3.0)分&(7.2±3.0)分、APACHEⅡ评分(23.1±8.3)分&(23.0±8.5)分及SOFA评分(11.0±3.2)分&(11.1±3.4)分均无明显变化。CRRT组28 d生存率显著提高(P<0.05);而无肾损害的CRRT亚组患者治疗前后APACHEⅡ评分(20.5±6.4)分&(18.4±6.8)分也有明显下降(P<0.05)。但Marshall评分(5.7±2.3)分&(5.5±2.4)分、SOFA评分(10.0±2.8)分&(9.5±3.2)分均无明显改善(P>0.05)。无肾损害的常规治疗亚组治疗前后Marshall评分(6.9±3.2)分&(7.2±3.2)分、APACHEⅡ评分(21.9±8.2)分&(21.7±9.0)分及SOFA评分(10.1±3.2)分&(10.3±3.2)分均无明显改善,P>0.05,28 d生存率无显著提高(P>0.05)。结论早期行连续性肾脏替代疗法治疗Objective To explore the efficacy of continuous renal replacement therapy(CRRT)in patients with multiple organ dysfunction syndrome(MODS)without renal damage.Methods A retrospective analysis was made of 190 MODS patients admitted to the emergency department of Sun Yat Sen Memorial Hospital of Sun Yat sen University from March 30,2012 to February 1,2018,including 113 males and 77 females,aged 14-97 years with an average age of(61.8)years.A total of 190 patients with MODS were divided into two groups:One group(87 patients,including 29 cases without renal injury)received conventional treatment including etiological treatment,anti-inflammatory treatment,organ function support and other measures;continuous renal replacement therapy was not selected as the conventional treatment group;another group in addition to routine therapy plus with continuous renal replacement therapy,as CRRT group,a total of 103 cases(including 20 patients without renal damage).Two groups of patients were compared before and after treatment for 24 h Marshall score,acute physiology and chronic health rating systemⅡ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)score,sequential organ failure(sequential outraged failure assessment,SOFA)score and 28 d survival rate of the two groups.Comparison was also made between the two groups of patients without renal damage of 24 h before and after treatment of two subgroups Marshall score,APACHEⅡscore,SOFA score and survival rate to evaluate the effect of CRRT 28 days.Results Marshall score before and after the CRRT treatment group(7.2±2.6)and(6.7±2.8),APACHEⅡscore(24.0±7.8)and(19.7±7.5)and the SOFA score(11.8±2.6)and(10.7±3.1)were significantly decreased(P<0.05).The conventional treatment group before and after treatment Marshall score(7.0±3.0)and(7.2±3.0),APACHEⅡscore(23.1±8.3)and(23.0±8.5)and the SOFA score(11.0±3.2)and(11.1±3.4)had no obvious changes.The survival rate of CRRT group was significantly improved at 28 days(P<0.05).Without renal damage of CRRT subgroups before

关 键 词：多器官功能障碍综合征 连续性肾脏替代疗法 中期生存率 

分 类 号：R47[医药卫生—护理学]