RIFLE标准在高容量血液滤过治疗MODS患者疗效的评价

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AKl分期作为HYI-IF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0CU）住院时间（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24h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AKIⅠ期行HVHF的疗效更好。

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

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.