脉冲式高容量血液滤过治疗脓毒症合并急性肾损伤患者的疗效及预后分析

Effects of pulse high volume hemofiltration on sepsis with acute kidney injury and analyses of factors affecting prognosis

目的:评价脉冲式高容量血液滤过(PHVHF)治疗脓毒症合并急性肾损伤患者的疗效,并分析影响预后的因素。方法:回顾性分析接受PHVHF治疗的56例患者的临床资料,对治疗前后生命体征、生化指标、炎症指标、急性生理与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(SOFA)评分进行比较。根据28 d存活情况,将患者分为存活组和死亡组,组间比较PHVHF治疗前临床资料的差异,多元回归分析影响预后的因素。运用受试者工作特征曲线(ROC)评价APACHEⅡ评分及SOFA评分对预后的判断价值。结果:56例患者死亡19例,病死率34%,明显低于APACHEⅡ评分预测的病死率(52.83%)。与治疗前相比,治疗72 h后体温、心率、呼吸明显下降(P<0.01),白细胞、C反应蛋白、降钙素原(PCT)、乳酸、肌酐、APACHEⅡ评分及SOFA评分明显降低(P<0.01)。死亡组的年龄、血源性感染比例、呼吸频率、乳酸浓度、低血压发生率、机械通气比例、脏器衰竭个数、APACHEⅡ评分及SOFA评分均高于存活组(P<0.05),多因素Logistic回归分析提示:呼吸衰竭使用机械通气(OR=29.841,95%CI:2.22~401.12,P=0.01)、脏器衰竭个数(OR=10.080,95%CI:1.277~79.581,P=0.028)、SOFA评分(OR=1.922,95%CI:1.013~3.646,P=0.028)是预后的独立影响因素。APACHEⅡ评分、SOFA评分的ROC曲线下面积(AUC)分别为0.885和0.910。结论:PHVHF治疗脓毒症合并AKI患者安全有效,可降低死亡率。呼吸衰竭使用机械通气、脏器衰竭个数、SOFA评分是死亡的独立危险因素。

Objective:To evaluate the efficacy of pulse high volume hemofiltration(PHVHF)in the treatment of sepsis with acute kidney injury(AKI),and to analyze the influencing factors of prognosis.Method:A total of 56 patients undergoing PHVHF were retrospectively analyzed.Vital signs,inflammatory markers,biochemistry index,acute physiology and chronic health evaluation(APACHE)Ⅱscore as well as sequential organ failure assessment(SOFA)score were compared before and after the treatment for 72 h.The patients were divided into the survival group and the death group according to the outcome of the 28-day.By comparing the two groups,the predictors of prognosis were summarized.Risk factors influencing prognosis were examined by multivariate logistic regression analysis.The receiver operating characteristic curve(ROC)were used to evaluate the prognostic values of APACHEⅡand SOFA score.Result:Nineteen patients(34%)died among 56 patients.28-day mortality was significantly lower than the mortality(52.83%)predicted by APACHEⅡscore.Patients in the death group were older,and they had higher percentage of blood-borne infection,percentage of mechanical ventilation and incidence of hypotension than in the survival group.Respiratory rate,lactic acid,number of organ failure,APACHEⅡscore and SOFA score were also higher in the death group.Multivariate logistic regression analysis confirmed that mechanical ventilation(OR=29.841,95%CI:2.22-401.12,P=0.01),number of organ failure(OR=10.080,95%CI:1.277-79.581,P=0.028)、SOFA score(OR=1.922,95%CI:1.013-3.646,P=0.028)were independent prognostic factors of sepsis with AKI.The areas under the ROC curve of APACHEⅡscore and SOFA score were 0.885 and 0.910 respectively.Conclusion:PHVHF has a significant effect on sepsis with AKI,and it can reduce mortality.The requiring of mechanical ventilation in respiratory failure、the number of organ failure and high SOFA score are independent risk factors of death of sepsis with AKI patients。