连续性血液净化在ICU多器官功能障碍综合征合并急性肾衰竭患者的应用及预后分析

目的探讨连续性血液净化治疗（CBPT）在ICU多器官功能障碍综合征（MODS）合并急性肾衰竭（APF）患者的疗效及影响预后的相关因素。方法回顾性分析2004年1月至2008年2月该院ICU中行连续性静-静脉血液滤过（CVVH）治疗的245例MODS合并ARF患者一般资料、血液生化检查、疾病严重程度评分等，对比分析CVVH治疗前后临床参数的变化及影响预后的因素。结果CVVH对容量负荷、溶质清除效果明显；反映疾病严重程度如氧合指数、APACHEⅡ评分、MODS评分、SOFA评分CVVH治疗前后比较无明显差异；全部患者死亡率为64．9％，病死率随着衰竭器官数目的增加而显著升高。多因素回归分析显示，患者CVVH治疗前衰竭器官数、医院获得性ARF、CVVH前APACHEⅡ评分、平均动脉压是独立危险因素。结论对于MODS合并ARF患者，CVVH治疗前患者疾病的严重程度是影响预后的重要因素，依据患者临床病情早期积极CBPT可能改善MODS合并ARF患者的预后。

Application and prognostic analysis of continuous blood purification in the treatment of patients complicated with multiple organ dysfunction syndrome and acute renal failure in ICU

Objective To investigate the application and prognosis of continuous blood purification treatment（CBPT） in patients complicated with multiple organ dysfunction syndrome （MODS） and acute renal failure（ARF） in ICU. Methods The general conditions, blood biochemical indicators and score of disease severity of 245 patients complicated with MODS and ARF treated with continuous veno-venous hemofiltration （CWH） in ICU of the First Affiliated Hospital of Guangxi Medical University during January 2004 to February 2008 were retrospectively analyzed, the changes of clinical data were compared before and after CVVH and also analyzed the risk factors of prognosis. Results CVVH effectively excreted extra volume overload and solutes; the oxygenate index, APACHE Ⅱ soore,MODS score and SOFA score of the patients were insignificantly different compared before and after CVVH;the overall mortality rate in hospital was 64.9%, the mortality also increased with the number of failure organ. Multivariate logistic regression analysis showed that the number of failure organ, hospital-acquired ARF, APACHE Ⅱ score, mean arterial pressure of patients before CVVH were independent risk factors for prognosis. Conclusion The degrees of severity of illness before the treat- ment of CVVH was important factor to the prognosis, earlier CBPT may improve the prognosis for the patients complicated with MODS and ARF in ICU.