连续性血液净化在合并急性肾损伤的MODS患者中的治疗时机探讨

目的：探讨连续性血液净化（CBP）在合并急性肾损伤（AKI）的多脏器功能障碍综合征（MODS）患者中治疗的时机。方法：回顾性研究2006年1月～2009年12月我院重症监护病房（ICU）及急诊重症监护病房（EICU）行CBP治疗合并AKI的MODS患者84例,记录CBP治疗时一般情况、急性生理学和慢性健康状态评分（APACHEⅡ）、序贯性器官衰竭评分（SOFA）、升压药及呼吸机的应用,记录开始治疗的不同原因（氮质血症、液体负荷、少尿、高血钾、酸中毒）。开始治疗时血尿素氮≤25mmol/L的患者为早期干预组,血尿素氮〉25mmol/L为晚期干预组,比较两组的各项临床参数及院内病死率。结果：84例患者存活33例,死亡51例,总死亡率为60.7%。开始CBP治疗原因以氮质血症及少尿居多,分别为95.2%和78.6%。早期干预组的病死率为32.0%,晚期干预组的病死率为72.9%（P=0.000）。结论：对合并AKI的MODS患者需把握CBP治疗时机,早期治疗可改善预后。

Investigate the Timing of Initiation of Continuous Blood Purification in the Multiple Organ Dysfunction Syndrome (MODS) Patients Complicated with Acute Kidney Injury (AKI)

Objective：To discuss the timing of initiation of continuous blood purification （CBP） in the multiple organ dysfunction syndrome （MODS） patients complicated with acute kidney injury （AKI）.Methods：We retrospectively analyzed 84 MODS patients in ICU combined AKI treated with CBP in the period of Jan.2006 to Dec.2009.The APACHE Ⅱ scores,SOFA scores and other medical records were reviewed.Different indications for CBP （azotemia、fluid overload、hyperkalemia、oliguria、metabolic acidosis） were recorded.Patients were characterized as ＂early＂ or ＂late＂ starters,based upon whether the blood urea nitrogen （BUN） was less than or greater than 25 mmol/L,prior to CBP initiation.Compare the medical records and the mortality of the two groups.Results：The overall mortality in hospital rate was 60.7%.The most indications for CBP initiation were azotemia （95.2%） and oliguria （78.6%）.The mortality of the early was 32%,the late was 72.9% （P=0.000）.Conclusion：Earlier initiation of CBP may improve the prognosis of the MODS patients with AKI.