对早期多器官功能障碍综合征合并急性肾损伤患者行高容量血液滤过的 疗效

目的:探讨合并有急性肾损伤(AKI)的多器官功能障碍综合征(MODS)患者早期行高容量血液滤过(HVHF)治疗后对器官保护作用.方法:选择重症监护室于2008年6-2012年1月收治的MODS合并AKI并接受HVHF治疗的患者86例作为研究对象.根据RIFLE分级分为Risk组10例,Injury组17例,Failure组59例.记录患者HVHF治疗前后血肌酐(SCr)、氧合指数(PaO2/FiO2)、血管外肺水指数(EVLWI)、动脉血乳酸(Lac)、凝血酶原时间(PT)、天冬氨酸转氨酶(AST)、急性生理学与慢性健康状况评分系统Ⅱ (APACHE Ⅱ)评分以及28天存活率.结果:HVHF治疗后,Failure组SCr、EVLWI、Lac、PT、AST、APACHEⅡ评分均显著高于Risk组和Injury组,PaO2/FiO2显著低于Risk组和Injury组,差异有统计学意义(P＜0.05).Risk组和Injury组在HVHF治疗后各指标差异均无统计学意义(P＞0.05).Risk组28天存活率为60.0％,Injury组64.71％,Failure组存活率为66.10％,3组间差异均无统计学意义(P＞0.05).结论:早期HVHF治疗对MODS合并AKI患者的器官具有保护作用,值得临床进一步研究.

The Efficiency of Early High Volume Hemofiltration to Patients with Multiple Organ Dysfunction Syndrome Combined with Acute Kidney Injury

Objective: To investigate the efficiency of early high volume hemofiltration(HVHF) to patients with multiple organ dysfunction syndrome(MODS) combined with acute kidney injury(AKI).Methods: 86 patients with MODS combined with AKI and treated by HVHF in our hospital were involved into this study during June 2008-January 2012.They were divided into the Risk group with 10 cases,Injury group with 17 cases,and Failure group with 59 cases according to RIFLE.Serum creatinine(SCr),oxygenation index(PaO2/FiO2),extravascular lung water index(EVLWI),lactate(Lac),prothrombin time(PT),aspartate aminotransferase(AST),Acute Physiology And Chronic Health Evaluation System II(APACHE II) and 28-day survival rate before and after HVHF treatment were recorded.Results: SCr,EVLWI,Lac,PT,AST,APACHEII in the Failure group were significantly higher than those in the Risk group and Injury group after HVHF treatment.PaO2/FiO2 in the Failure group was significantly lower than the Risk Group and Injury group.The differences were statistically significant(P<0.05).The differences of indexes in the Risk Group and Injury group after HVHF treatment were not statistically significant the(P>0.05).The 28-day survival rate in the Risk Group was 60.0%.It was 64.71% in the Injury group,and 62.71% in the Failure group.The differences among the three groups were not statistically significant(P>0.05).Conclusions: HVHF treatment was effective to protect the organs of patients with early MODS combined with AKI.It was suggested to take further clinical studies.