血液滤过治疗急性肾功能衰竭伴多脏器功能衰竭的疗效观察

Effect of continuous renal replacement therapy on acute renal failure complicated by multiple organ dysfunction syndrome

目的 探讨CRRT用于急性肾功能衰竭 (ARF)伴多脏器功能障碍综合征 (MODS)患者的治疗方法和疗效。方法 利用全身感染相关器官功能衰竭评分 (SOFA) ,对两年来ARF伴多脏器功能障碍综合征(MODS)行CRRT治疗的 12例死亡患者和 8例存活患者资料进行回顾分析。结果 入ICU时APACHE -Ⅱ分值存活组低于死亡组 (P =0 .0 4 )。CRRT开始时存活组SOFA分值低于死亡组 (P =0 .0 4 )。存活组循环SOFA分值由 (1.80± 1.30 )降至 (0 .5 0± 0 .5 8) (P =0 .0 2 8) ,明显低于死亡组 72小时分值 (P =0 .0 16 )。总SO FA分值治疗前后死亡组未见显著变化 ,存活组则降至 (6 .6 0± 3.36 ) (P =0 .0 2 1)。死亡组患者SOFA持续在较高水平 ,CRRT开始时SOFA分值为 (14 .0 9± 3.5 9) ,与存活组有明显差异 (P =0 .0 18)。与治疗前比较 ,治疗后SOFA分值存活组明显下降 ,死亡组未见此变化。比较入ICU到开始血液净化时间 ,存活组 (1.4 3± 0 .78)明显早于死亡组 (4.91± 5 .38) (P =0 .0 30 )。结论 肾脏以外器官功能损害较重可能是患者死亡的主要原因 ,如果能够尽早开始CRRT治疗 。

Objective To evaluate the effect of continuous renal replacement therapy (CRRT) on acute renal failure (ARF) complicated by multiple organ dysfunction syndrome (MODS) and its technique. Methods Sequential organ failure assessment scores (SOFA)were used to assess the data of the patients with ARF complicated by MODS and the effects of CRRT on the survival patients (8 cases) and death patients (12 cases).Results At the time of entering the ICU, the APACHE-Ⅱ score of the survival group is less than the death group (P=0.04). At the moment the CRRT started, the SOFA score of the survival group is lower than the death group (P=0.018). The circulatory SOFA score in the survival group decreased from (1.80±1.30) to (0.50±0.58)(P=0.028), significantly lower than that of the death group at the 72 hour of CRRT therapy (P=0.016). The total SOFA score in the death group had no significant alteration, but it decreased significantly in the survival group(P=0.021). The SOFA score in the death group was continuously at a high level. At the beginning of the therapy, the SOFA score (14.09±3.59) in the group is significantly higher than the survival group (9.40±3.65) (P=0.030). After the therapy, the SOFA score in the survival group decreased and that in the death group did not derease. Comparing the period from entering ICU to starting CRRT,that of the survival group (1.43±0.78) is significantly shorter than that of the death group (4.91±5.38)(P=0.030). Conclusion Severe damage of non-renal organs' function may be the major cause of death. If we initiate the CRRT therapy as earlier as possible, the prognosis of these patients may be improved.