危重型肾综合征出血热患者肾脏替代治疗的应用

Application of Renal Replacement Therapy in Critical Patients with Hemorrhagic Fever and Renal Syndrome

目的观察危重型肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者肾脏替代治疗(renal replacement therapy,RRT)的疗效及在急性肾损伤(acute kidney injury,AKI)不同时期开展RRT对机体预后的影响。方法对我中心2008年1月—2012年8月住院的77例危重型HFRS的临床资料进行回顾性分析。结果保守治疗组患者的住院病死率高于RRT组(P<0.05)。AKI早期组患者的住院病死率、难治性休克发生率、机械通气率和血管活性药物使用率均高于晚期组(P<0.05)。死亡患者急性期血清肌酐低于存活患者,白细胞计数和血浆乳酸水平高于存活患者,心力衰竭、ARDS、消化道出血和脑病发生率高于存活患者,AKI 3期发生率低于存活患者(P<0.05)。结论 RRT是救治危重型HFRS的重要支持手段,但不能单纯依靠AKI程度确定行RRT的最佳治疗时机,在行RRT前需对患者病情进行系统全面的评估。

Objective To observe curative effects of renal replacement therapy （RRT） and the influence on the prognosis of acute kidney injury （AKI） during different stages in critical patients with hemorrhagic fever and renal syn- drome （HFRS）. Methods Clinical data of 77 critical inpatients with HFRS during January 2008 and August 2012 was retrospectively analyzed. Results The hospitalization fatality rate of conservative group was significantly higher than that of RRT group （P 〈 0.05）. The hospitalization fatality rate, incidence rate of refractory shock, mechanic ventilation rate and usage rate of vasoactive agents in prophase AKI group were significantly higher than those in advanced AKI group （P 〈 0.05）. Compared with those in survivors, the non-survivors had lower serum creatinine （Scr） level, but higher levels of white blood cell count （WBC） and plasma lactic acid, and higher incidence rates of heart failure, ARDS, alimentary tract hemorrhage and encephalopathy during the acute stage, while the incidence rate of stage III of ARF was significantly lower （P 〈 0.05 ）. Conclusion RRT is an indispensable supportive therapeutic way for critical patients with HFRS. The optimal therapic time of RRT can not be independently determined based upon the AKI degrees, and the patients＇ condition should be systematically and comprehensively evaluated before RRT.