APACHEⅡ在连续性肾脏替代治疗危重症患者疗效及预后中的作用

Value of APACHEⅡ in the therapeutic effect and prognosis of CRRT in critically ill patients

目的研究急性病生理学和长期健康评价(APACHE)Ⅱ评分对连续性肾脏替代治疗(CRRT)危重症患者疗效及预后的评价作用。方法以2010年1月至12月收住重症监护病房(ICU)行CRRT的65例危重症患者为研究对象,根据其预后分为死亡组(45例)和生存组(20例),比较两组之间年龄、性别比、血尿素氮(Bun)、血肌酐(Cr)、血清钠离子浓度(Na+)、血清钾离子浓度(K+)、血碳酸氢根浓度(HCO3-)、乳酸、APACHEⅡ评分的差异,分析影响CRRT患者预后的危险因素。观察CRRT治疗72h后患者的Bun、Cr、Na+、K+、HCO3-、乳酸、APACHEⅡ分值的变化。结果死亡组和存活组的年龄、性别比、Bun、Cr、Na+、K+、HCO3-比较无统计学意义(P均>0.05);死亡组的乳酸和APACHEⅡ评分明显高于生存组(P均<0.05),logistic回归分析显示APACHEⅡ评分为影响CRRT患者预后的危险因素(P=0.029),而乳酸、年龄与预后无相关性(P=0.066;P=0.168)。APACHEⅡ评分分组分析发现,当APACHEⅡ>30分时,患者的病死率高达81.8%。行CRRT治疗72h后患者Bun、Cr、Na+、K+、HCO3-水平及APACHEⅡ评分明显改善(P均<0.05);乳酸水平虽有下降,但无统计学意义。结论 APACHEⅡ分值可用于早期预测患者预后及评价危重症患者CRRT疗效。

Objective To investigate the acute physiology and chronic health evaluationⅡ （APACHEⅡ ） in evaluating the therapeutic effects and prognosis of continuous renal replacement therapy （CRRT） in critically ill patients. Methods A total of 65 critically ill patients treated with CRRT from January to December, 2010 hospitalized in the intensive-care unit, Tongde Hospital of Zhejiang Province, were enrolled in the study. All the cases were allocated to the survival group （20 cases） and death group （45 cases） according to the prognosis. Their age, sex ratio, the levels of Bun, Cr, Na＋, K＋, HCO3-, lactic acid, APACHEⅡ score before starting CRRT were compared between the two groups, and multinomial logistic regression was applied to explore the risk factors. All the indices were observed and compared between before and 72 h after CRRT. Results The levels of APACHE Ⅱ score and lactic acid were much higher in the death group than the survival group （all P〈 0.05）, but no significance was noted in other indices （all P〉 0.05）. Logistic regression analysis showed that APACHE Ⅱ is the only variable associated with death （P= 0.029）. The mortality rate was higher （81.8%） in the group of APACHE Ⅱ score 〉 30. The levels of Bun, Cr, Na＋, K＋, HCO3-, APACHE Ⅱ score were markedly improved at 72 h after CRRT, compared with before CRRT （all P 〈 0.05）, but no statistically significant decrease was noted in lactic acid （all P〉 0.05）. Conclusion APACHE Ⅱ score can be applied to evaluate the therapeutic effects of CRRT and predict the mortality in critically ill patients earlier.