血液净化治疗多器官功能不全伴急性肾损伤患者的预后分析

Prognostic Analysis of Blood Purification in Patients with Multiple Organ Dysfunction and Acute Renal Injury

目的探讨分析肾脏替代治疗(CRRT)多器官功能不全(MODS)伴急性肾损伤(AKI)患者的临床疗效及影响其预后的相关因素。方法选取2014年1月—2015年5月我院收治的96例行CRRT的合并AKI的MODS患者作为研究对象,采用系统性回顾法分析其临床及随访,分析其CRRT治疗临床疗效及探讨可能影响其预后的相关因素。结果不同分期AKI患者其病死率比较无统计学意义(P>0.05);好转组患者其年龄、Scr浓度、器官衰竭个数、多巴胺使用量、序贯性器官衰竭评估(SOFA)评分、MODS评分及急性生理与慢性健康状态Ⅱ(APACHEⅡ)评分均明显低于死亡组患者(P<0.05);本组研究患者病死率与器官衰竭个数有着密切联系(P<0.05),但器官衰竭个数和病死率与AKI分期均无明显联系(P>0.05);性别、是否机械通气、是否使用多巴胺及AKI发生地点均为影响合并AKI的MODS患者予CRRT治疗预后的因素;发生地点(医院)、器官衰竭个数(≥4)、多巴胺的使用及APACHEⅡ评分(>20分)是影响合并AKI的MODS患者CRRT后其预后生存的独立危险因素(P<0.05)。结论AKI不同分期对合并AKI的MODS患者预后无明显影响,而AKI发生地点(医院)、器官衰竭个数(≥4)、多巴胺的使用(需要)及治疗前患者APACHEⅡ评分(>20分)为合并AKI的MODS患者CRRT后预后生存的独立危险因素。

Objective To investigate the clinical efficacy of blood purification in patients with multiple organ dysfunction and acute renal injury and the related factors that affect prognosis.Methods A total of 96 patients with MODS and AKI who had undergone CRRT between January 2014 and May 2015 in our hospital were selected as subjects.The clinical and follow-up data was analyzed by systematic review.The clinical efficacy of blood purification and related factors affecting prognosis were observed.Results The mortality of patients with AKI in different stages was not statistically significant（P〉0.05）.Age,Scr,the number of organ failures,use of dopamine,SOFA score,MODS score and APACHEⅡscore of the improved group were far below those of the death group（P〈0.05）.There was a close relationship between mortality and the number of organ failures（P〈0.05）,neither of which was significantly correlated with AKI stage（P〉0.05）.Sex,use of mechanical ventilation or dopamine and the location of AKI were factors that affected the prognosis of patients.Places of occurrence（inside a hospital）,the number of organ failures（≥4）,use of dopamine and APACHEⅡscore（〉20 points）were independent risk factors for prognosis of MODS patients with AKI.Conclusion There is no significant difference in the prognosis of patients with MODS and AKI in different stages.The place of occurrence,number of organ failures（≥4）,use of dopamine and APACHEⅡscore（〉20 points）are independent risk factors for prognosis of MODS patients with AKI.