连续性肾脏替代疗法治疗重症急性肾功能衰竭的临床研究

目的 评价连续性肾脏替代疗法(CRRT)治疗重症急性肾功能衰竭(ARF)的临床应用价值及影响预后的因素。方法 回顾分析CRRT治疗(CRRT组)的116例重症ARF患者的临床特点、疾病严重程度及其预后,并与同期行间歇性血液透析(IHD)治疗(IHD组)的102例重症ARF患者相对照。结果 (1)CRRT组患者的平均APACHEⅡ评分为27.0±7.5,其中≥29分56例(48%),24~29分36例(31%),<24分24例(21%);而IHD组患者的平均APACHEⅡ评分为21.9±5.2,其中≥29分0例(0%),24~29分44例(43%),<24分58例(57%)。CRRT组平均APACHEⅡ评分显著高于IHD组(t=4.769,P=0.000),提示CRRT治疗的患者多为病情危重的重症病例。(2)CRRT组患者治疗后的存活率为37%(43/116),而IHD组为48%(49/102),两组比较无显著性差异(χ²=2.678,P=0.1018);若仅选取APACHEⅡ评分≥24分的危重病人进行比较显示:CRRT组的存活率24%(22/92)显著高于IHD治疗组的9%(4/44)(χ²=4.229,P=0.0397),提示对危重ARF患者,CRRT效果优于传统IHD。(3)对CRRT存活与死亡亚组患者的一般临床资料、疾病的严重程度(用APACHEⅡ评分表示)等因素进行统计学分析,结果显示死亡亚组患者的年龄、病情严重程度以及需要使用机械通气和升压药的百分率明显高于存活亚组(P<0.05)。结论 (1)CRRT是治疗重症AFR的有效方法之一

Continuous renal replacement therapy for severe acute renal failure

Objective To estimate the clinical value of continuous renal replacement therapy (CRRT) in the treatment of severe acute renal failure (ARF) and identify the factors influencing the patients’ prognosis. Methods The clinical characteristics, disease severity and prognosis were retrospectively studied in 116 patients with severe ARF undergoing CRRT from January, 1998 to May, 2004, in comparison with those in 102 such patients treated with intermittent hemodialysis (IHD). Results The mean score of Acute Physiology and Chronic Health Evaluation II (APACHE II) was 27.0±7.5 in patients receiving CRRT, of whom 56 (48%) had a score no less than 29, 36 (31%) between 24 to 29 and 24 (21%) less than 24. The mean APACHE II score was 21.9±5.2 in patients with IHD, and none of them had a score over 29, 44 (43%) had a score between 24 to 29 and 58 (57%) less than 24. The mean APACHE II score of CRRT group was significantly higher than that of IHD group (t=4.769, P=0.000), suggesting that most of the patients treated with CRRT were in critical condition. The patients’ survival rate, however, did not differ significantly between the two groups, being 37% (43/116) in CRRT group and 48% (49/102) in IHD group (χ²=2.678, P=0.101 8). When only the patients with a score no less than 24 were compared, the survival rate of CRRT group was significantly higher than that of IHD group (24% vs 9%, χ² =4.229, P=0.039 7), demonstrating better effect of CRRT than IHD in the management of critical ARF cases. In patients treated with CRRT, the patients in fatal cases had significantly older age, more critical condition (indicated by APACHE II score) and greater dependence on mechanical ventilation or vasoactive support than those who survived (P<0.05). Conclusions CRRT is one of the effective methods for management of severe ARF patients, especially in those with critical conditions, with better effect than that of IHD. The prognosis of severe ARF patients treated with CRRT can be influenced by the patients’ age and disease severity, and the need of vasoactive drugs or mechanical ventilation may help predict the patients’ prognosis.