中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (05): 367-371.doi: 10.3969/j.issn.1671-4091.2014.05.003

• 临床研究 • 上一篇    下一篇

RIFLE分级对连续性血液滤过治疗急性肾损伤患者预后的评估价值

高月花1,韦加美1,孙清海2,李爽1,黄红1,高建军1,那宇1   

  1. 1. 解放军第306医院肾内科
    2. 首都医科大学附属北京佑安医院
  • 收稿日期:2013-11-04 修回日期:2014-02-28 出版日期:2014-05-12 发布日期:2014-05-11
  • 通讯作者: 那宇 nysnd0701@sina.com E-mail:nysnd0701@sina.com
  • 基金资助:

    全军医药卫生“十一五”计划专项课题(10MA020)；全军医药卫生“十二五”计划专项课题(AWS11J03)

The impact of RIFLE grading on the evaluation of clinical outcomes in acute renal injury patients treated with continuous renal replacement therapy

  • Received:2013-11-04 Revised:2014-02-28 Online:2014-05-12 Published:2014-05-11

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摘要： 目的 评估RIFLE分级定义的连续性血液净化治疗时机(continuous renal replacement therapy, CRRT)对急性肾损伤（acute kidney injury, AKI）患者预后的影响。方法 选取符合AKI诊断标准并行CRRT治疗的患者87例，RIFLE危险期定义为早期，损伤期、衰竭期定义为晚期，早期透析组31例，晚期透析组56例。记录一般临床资料，观察透析开始后28天、90天死亡率、肾功能恢复率。结果 ⑴早期透析组、晚期透析组28天、90天死亡率比较分别为64.52% vs 57.14%、67.74% vs 66.07%，P＞0.05。Kaplan-Meier生存曲线提示两组生存时间无显著差别（P=0.67）。两组透析患者28天、90天死亡风险无明显差别，28天RR=0.724 (P=0.489)，90天RR=0.921 (P=0.864)。⑵早期透析组、晚期透析组28天、90天肾功能恢复率比较分别为38.70% vs 30.36%、38.70% vs 32.14%，P＞0.05。两组透析患者28天、90天不能脱离透析的危险无显著差异，28天RR=1.449 (P=0.430)，90天RR=1.333 (P=0.538)。⑶Cox多因素分析显示APACEII是AKI患者死亡的危险因素。结论 RIFLE分级作为AKI患者CRRT治疗时机，不能预测患者死亡率与肾功能恢复率。

关键词: 连续性血液净化, 急性肾损伤, 治疗时机, RIFLE

Abstract: Objective To evaluation the relationship between the initiation of continuous renal replacement therapy (CRRT) guided by RIFLE grading and clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods We recruited 87 AKI patients treated with CRRT in the period from 2010 to 2013. They were divided into early (RIFLE classified as risk, n=31) and late (RIFLE classified as injury or failure, n=56) initiation of CRRT by RIFLE criteria. Their demographic data and biochemistry parameters were collected. Clinical outcomes including mortality and renal function recovery were recorded. Results After the initiation of CRRT, the mortality rate at the 28th day was 64.52% and 57.14% in the early group and late group, respectively, and that at the 90th day was 67.74% and 66.07% in the early group and late group, respectively (P＞0.05). Kaplan- Meier curve revealed that the survival estimates were similar between the two groups (P=0.67). The relative death risks at the 28th and 90th days were also similar between the two groups (RR=0.724 and 0.921, respectively; P＞0.05). Renal function recovery at the 28th day was 38.70% and 30.36% in the early group and late group, respectively, and that at the 90th day was 38.70% and 32.14% in the early group and late group, respectively (P＞0.05). The relative risks for renal function recovery at the 28th and 90th days were also similar between the two groups (RR=1.449 at the 28th day, P=0.430; RR=1.333 at the 90th day, P=0.538). Cox multivariate analyses revealed that APACHE II score was the death risk factor for AKI patients. Conclusions RIFLE classification as the guide for the initiation of CRRT could not be used to predict the mortality at the 90th day and the renal function recovery in AKI patients.

Key words: continuous renal replacement therapy, acute kidney injury, timing, RIFLE