血液净化治疗脓毒症致急性肾损伤的临床研究

The Clinicle Study of Purification Therapy on Acute Kidney Injury Induced by Sepsis

目的 研究脓毒症导致急性肾损伤采取不同血液净化治疗方式对患者预后的影响,以选择合适的治疗时机,提高患者的肾功能恢复率,降低病死率.方法 回顾性研究96例脓毒症合并AKI的患者;依据血液净化方式分为CBP组和IHD组,将CBP组参照AKI的RIFLE分期标准分为Ⅰ、Ⅱ、Ⅲ期;观察和评价全部患者进入ICU即刻、48 h、急性期末次血液净化结束后24 h的生命体征、实验室指标、APACHE Ⅱ评分动态变化和患者的不同预后.结果 ①CBP组与IHD组进入ICU即刻及进入ICU 48 h APACHE Ⅱ评分、肌酐差异没有统计学意义(P＞0.05),治疗结束后CBP组APACHE Ⅱ评分略低于IHD组;②CBP组与IHD组病死率分别为51.9%和52.4%,差异无统计学意义(P＞0.05),肾功能恢复率CBP组(80.8%)与IHD组(65.0%)比较差异有统计学意义(P＜0.05);③CBP组患者MAP、SpO2较IHD组低(P＜0.05),治疗后MAP、SpO2有所上升,差异具有统计学意义(P＜0.05);④CBP中Ⅰ期患者存活率78.6%、治疗前APACHEⅡ评分(25.4±2.5)、肾功能恢复率90.9%、APACHE Ⅱ变化率(-13.6±4.3),而Ⅲ期患者上述指标分别为38.1%、(36.1±5.7)、62.5%、(-7.1±4.2),差异有明显统计学意义(P＜0.01),Ⅰ期患者与全部患者肾功能恢复率差异具有统计学意义(P＜0.05).结论 CBP能改善脓毒症导AKI患者的预后;Ⅰ期患者和APACHE Ⅱ评分为22.9～27.9的患者存活率和肾功能恢复率均优于Ⅲ期患者及全部患者;因此,这类患者在选择血液净化开始时机时要充分考虑肾功能的变化情况,结合APACHE Ⅱ评分来综合判断.

Objective The study is aimed to observe the patients with acute kidney injury as a result of sepsis and the relationship with prognosis by two purification therapy models,to choose a suitble opportunity of purification and increase restoration rate of renal function, decrease death rate.Methods We reviewed retrospectively 96 AKI patients induced by sepsis in ICU during March, 2004 to September, 2006; 96 patients were allocated into two groups based on purification models of CBP group for 54 cases and IHD group for 42 cases. Meanwhile,we classi fied 54 CBP patients into three groups through RIFLE criteria for AKI. All of these patients'clinnic status and laboratory data、variation of APACHE Ⅱ were observed, and the prognosis of inter-groups were respectively evaluated on the day 0 hours and 48 hours in ICU、24 hours after the last purification in critical stage. Results ①We realized that APACHEⅡ score and blood Cr of two groups were not markly difference on the day 0 hours and 48 hours in ICU (P>0.05), however APACHEⅡ score of CBP group was shortly lower than that of IHD group.②Then, we observed that the death rate of two group was samely not statistical difference : CBP [51.9%] vs. IHD [52.4 %] ( P>0.05) , but the restoration rate of renal function was existed statistical difference :CBP[80.8 %]vs.IHD[65.0%] ( P<0.05).③Nextly, the observation exhibited that MAP and SpO2 of CBP were lower than IHD ( P<0.05). After CBP , MAP and SpO2 were meaningly increased ( P<0.05).④Finally, we find out that the first group(CBP)'survival rate was 78.6%、APACHEⅡ score before CBP was (25.4±2.5)、the restoration rate of renal function was 90.9%、APACHEⅡvariation was (-13.6 ± 4.3), these of the third group (CBP)were 38.1%、(36.1±5.7)、62.5%、(-7.1±4.2) ( P< 0.01). The first group vs.all patients (CBP) about the restoration rate of renal function was statistical difference (P<0.05). Conclusion CBP may improve prognosis of AKI patients induced by sepsis;the survival rate and restoration rate of renal function at the first group(CBP) and the patients with 22.9～27.9 APACHEⅡscore were better than the third group and all patients (CBP). Therefore, we should select a suitble purification opportunity according to APACHEⅡscore and the increace degree of renal function.