早期高容量血液滤过对多器官功能障碍综合征合并急性肾损伤患者的器官保护作用

目的 探讨早期持续高容量血液滤过(HVHF)对多器官功能障碍综合征(MODS)合并急性肾损伤(AKI)患者的器官保护作用.方法 收集本院重症医学科2006年6月至2011年6月因MODS合并AKI而行HVHF治疗的117例患者的临床资料,根据患者行HVHF治疗时的RIFLE分级(危险、损伤、衰竭、肾功能丧失、终末期肾病)分为3组,其中RIFLE-R组15例,RIFLE-I组23例,RIFLE-F组79例.记录3组患者HVHF治疗前及治疗后72 h内血肌酐(SCr)、氧合指数(PaO2/FiO2)、血管外肺水指数(EVLWI)、动脉血乳酸(Lac)、凝血酶原时间(PT)、天冬氨酸转氨酶(AST)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,同时计算患者90 d的存活率.结果 RIFLE-R组与RIFLE-Ⅰ组HVHF治疗后72 h内SCr、PaO2/FiO2、EVLWI、Lac、PT、AST、APACHEⅡ评分比较差异均无统计学意义.RIFLE-F组HVHF治疗后72 h内SCr、EVLWI、Lac、PT、AST、APACHEⅡ评分均高于RIFLE-R组和RIFLE-Ⅰ组[SCr(μmol/L):260.50±35.51比83.61±21.07、89.71土23.81;EVLWI (ml/kg):12.18±2.11比10.94±1.50、10.76±1.92;Lac(mmol/L):2.40±0.56比1.58土0.27、1.68±0.35;PT(s):14.14±1.50比12.67土1.18、12.51±0.94;AST (U/L):96.19±18.84比47.91土12.85、56.39±13.44; APACHE Ⅰ评分(分):20.17±2.61比17.79土2.65、18.53± 2.87,P＜0.05或P＜0.01],而PaO2/FiO2 (mm Hg,1 mm Hg=0.133 kPa)均低于RIFLE-R组和RIFLE-Ⅰ组(202.80土19.07比245.24±21.18、250.63±25.56,均P＜0.01).RIFLE-R组、RIFLE-Ⅰ组、RIFLE-F组患者90d存活率比较差异均无统计学意义(66.67%、65.22%、63.29%,均P＞0.05).结论 早期HVHF治疗对MODS合并AKI患者有器官保护作用.

A clinical study on organ protective effect of early high-volume hemofiltration (HVHF) in patients with multiple organ dysfunction syndrome (MODS) complicated by acute kidney injury (AKI)

Objective To investigate the organ protective effect of early continuous HVHF in patients with MODS complicated by AKI.Methods 117 patients requested HVHF in ICU due to MODS/AKI were enrolled from June 2006 to June 2011 for clinical data collection.The patients were categorized,by RIFLE scale (R-risk of renal dysfunction,I-injury to the kidney,F-failure of kidney,L-Ioss of kidney function,E-end stage kidney disease),into three groups:RIFLE-R (n = 15),RIFLE-I (n = 23) and RIFLE-F (n=79).The values of their serum creatinine (SCr),oxygenation index (Pa02/Fi02),extravascular lung water index (EVI.WI),blood lactic acid (Lac),prothrombin time (PT),aspartate aminotransferase (AST),acute physiology and chronic health evaluation I (APACHE I ) score were recorded,at the beginning of,and within 72 hours after HVHF.The 90-day survival rate in each group was calculated.Results No significant difference was found between RIFLE-R and RIFLE-I group,within 72 hours after HVHF,in SCr,Pa02/Fi02,EVLWI,Lac,PT,AST,or APACHE u score.The mean values of SCr,EVLWI,Lac,PT,AST,APACHE I score,within 72 hours after HVHF in the RIFLE-F group were significantly higher in comparison with RIFLE-R,and RIFLE-I group (SCr (pmol/L):260.50土 35.51 vs.83.61士 21.07,89.7l± 23.81; EVLWI (ml/kg):12.18士2.11 vs.10.94士1.50,10.76士1.92; Lac (mmol/L):2.40士 0.56 vs.1.58土 0.27,1.68士 0.35; PT (sec):14.14士 1.50 vs.12.67土 1.18,12.51士 0.94; AST (U/L):96.19士18.84 vs.47.91土 12.85,56.39± 13.44; APACHE rc score:20.17土 2.61 vs. 17.79士 2.65,18.53土2.87,PO.05).Conclusion Early HVHF has protective effect against organs injury in patients with MODS and AKL