伴发肾功能不全的多器官功能障碍综合征患者的临床特征及预后

Clinical characteristics and outcome in the patients with multiple organ dysfunction syndrome with renal dysfunction

目的 探讨伴发肾功能不全的多脏器功能障碍综合征 (MODS)患者的临床特征及预后。方法 对一综合性ICU中 6 0例MODS患者的临床特征进行回顾性分析 ,并比较了入院时APACHEⅡ评分、序贯器官衰竭估计 (sequentialorganfailureassessment,SOFA)评分对预后的预测作用。结果 6 0例MODS患者中发生肾功能不全 4 5例 (75 % ) ,未发生肾功能不全 15例 (2 5 % ) ,二组比较病死率无差异 ,但发生肾功能不全组器官衰竭个数、最大SOFA评分明显高于未发生肾功能不全组 (P <0 0 1)。在发生肾功能不全的患者中存活组与死亡组临床特征比较显示 ,两组在少尿、休克的存在、行机械通气治疗、器官衰竭的个数、入院后肾功能不全出现的时间、入院肾SOFA评分、肾最大SOFA评分及总最大SOFA评分差异有显著意义(P <0 0 5 )。少尿组与非少尿组患者临床特征比较显示少尿组患者病死率、器官衰谒个数、总最大SOAF评分、肾最大SOFA评分明显高于非少尿组 (P <0 0 1)。结论 在MODS中肾脏损害较普遍。伴发肾功能不全的MODS患者中影响预后的因素主要有少尿、休克的存在、行机械通气治疗、器官衰竭的个数、迟发的肾功能衰竭。SOAF评分对估计MODS患者的病情及预测预后具有良好的临床应用价值。

Objective To study clinical characteristics and outcome in the patients with multiple organ dysfunction syndrome(MODS) with renal dysfunction.Methods A retrospective analysis was made in 60 patients with MODS in a general ICU.Admission APACHEII score and sequential organ failure assessment(SOFA) score were used to measure outcome.Results Out of 60 patients with MODS,renal dysfunction occurred in 45 patients(75%).The number of failed organs and renal maximum SOFA score in renal dysfunction group were significantly higher than that in without renal dysfunction group(P<0 01).The mortality rates were not different between two groups.The oliguria,septic shock,mechanical ventilation,number of failed organs,the time of renal dysfunction,renal SOFA admission score,total maximum SOFA scores and renal maximum SOFA score were significantly higher in surviors than in nonsurvivors of MODS with renal dysfunction(P<0 05).The mortality rate,number of failed organs,total maximum SOFA scores and renal maximum SOFA score in oliguria group were significantly higher than that in nonoliguria goup(P<0 01).Conclusion The impairment of renal function is common in patients with MODS.Oliguria,septic shock,mechanical ventilation,number of failed organs and delayed occurrence of acute renal impairment were predictors of a worse prognosis in patients of renal dysfunction with MODS.Admission scores cant be used to measure outcome in patients with MODS.The SOFA score was a good method to assess the severity of illness and to measure outcome in patients with MODS. [