高容量血液滤过治疗脓毒症并发多器官功能障碍综合征RIFLE标准应用研究

目的探讨RIFLE标准衡量高容量血液滤过(HVHF)治疗脓毒症并发多器官功能障碍综合征(MODS)的治疗时机及其对预后的影响。方法回顾性分析成都军区总医院2006年1月至2010年12月行HVHF治疗的脓毒症并发MODS患者52例,采用RIFLE标准分A组(AKIⅠ期)、B组(AKIⅡ期)和C组(AKIⅢ期),比较各组的病死率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间,并将HVHF治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血浆白介素(IL)-6、氧合指数、血肌酐(Scr)及平均动脉压(MAP)等指标。结果 (1)C组HVHF治疗前APACHEⅡ评分、SOFA评分、血浆IL-6及病死率均明显高于A、B组(P<0.01);(2)A、B组HVHF治疗前APACHEⅡ评分、SOFA评分及病死率比较差异无统计学意义(P>0.05),但B组HVHF治疗前IL-6及平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间明显高于或长于A组(P<0.01);(3)HVHF治疗24 h后血浆IL-6、氧合指数、Scr、MAP均明显改善,但C组IL-6仍高于A、B组(P<0.01),B组IL-6仍高于A组(P<0.01);A、B组HVHF治疗24 h后APACHEⅡ评分、SOFA评分显著降低(P<0.01),C组无变化(P>0.05)。结论 HVHF能有效辅助治疗脓毒症并发MODS;RIFLE标准及IL-6对判断预后有指导意义;早期(AKIⅠ期和Ⅱ期)行HVHF可明显改善脓毒症并发MODS的预后,而AKIⅠ期行HVHF的疗效更好。

RIFLE criteria for evaluation of high-volume hemofiltration in treatment of patients with sepsis multiple organ dysfunction syndrome

Objective To explore the use of RIFLE criteria in evaluation of therapeutic time of high-volume hemofiltration(HVHF) in treatment of sepsis complicated with multiple organ dysfunction syndrome(MODS) and the effects of HVHF on prognosis.Methods Between January 2006 and September 2010,52 patients with sepsis and MODS undergoing HVHF in Chengdu PLA General Military Hospital were retrospectively analyzed and divided into group A(AKI Ⅰ),group B(AKI Ⅱ) and group C(AKI Ⅲ) according to the RIFLE criteria.The mortality rate,mean ICU stay,mean mechanical ventilation time and the mean time of continuous HVHF treatment were compared among three groups.Moreover,indexes such as APACHEⅡ score,sequential organ failure assessment(SOFA) score,serum interleukin-6(IL-6),oxygenation index,plasma creatinine(Cr) and mean arterial pressure(MAP) before and at 24 h after HVHF treatment were also compared.Results(1)APACHEⅡ score,SOFA score,plasma IL-6 and the mortality rate in group C were significantly higher than those in groups A and B before HVHF treatment(P<0.01);(2)There were no significant differences in APACHE Ⅱ score,SOFA score and the mortality rate in groups A group B before HVHF treatment(P>0.05),however,serum IL-6,mean ICU stay,mean mechanical ventilation time and the mean time of continuous HVHF treatment in group B were remarkably higher than those in group A(P<0.01);(3)The plasma IL-6,oxygenate index,serum creatinine(Cr) and MAP were improved significantly at 24 h after HVHF treatment.Nevertheless,IL-6 in group C was still higher than those in groups A and B,and IL-6 in group B was higher than that in group A(P<0.01);APACHE Ⅱ score and SOFA score were decreased significantly in groups A and B(P<0.01),while no change was found in group C(P>0.05).Conclusion HVHF can be useful in assisting treatments for sepsis complicated with MODS;RIFLE criteria and IL-6 may help prediction of prognosis;Early HVHF treatment can remarkably improve the prognosis of sepsis complicated with MODS in stages AKI Ⅰand Ⅱ,while the efficacy of HVHF treatment can be better in AKI Ⅰstage.