【摘要】目的 分析连续性肾脏替代治疗(cotinuous renal replacement therapy,CRRT)患者预后的相关危险因素，探讨急性生理学与慢性健康状况评分(acute physiology and chronic health evaluation,APACHE)在CRRT患者中的临床应用。方法 以上海交通大学医学院附属瑞金医院2006年行CRRT的各科危重患者为研究对象，于CRRT前24 h内计算APACHE Ⅱ、Ⅲ，并估算患者的死亡风险系数。采用SPSS 15.0医学统计软件，计量资料均以`x±s表示，率的比较用卡方检验，组间比较用单样本t检验，以P＜0.05为差异有统计学意义。危险因素分析采用logistic多因素回归分析。结果 收集2006年CRRT患者113例，平均年龄为(60.4±17.4)岁，男/女为74/39；ICU患者47例，非ICU患者66例；存活47例，死亡66例，总病死率为58.4%。APACHE Ⅱ均值为(26.3±7.7)分，风险系数0.47±0.26；死亡组为(29.2±8.1)分，存活组为(22.4±4.8)分，两者之间差异有统计学意义(P＜0.001)。APACHE Ⅲ均值(91.4±29.0)分，风险系数0.77±0.27；死亡组为(104.7±28.6)分，存活组为(72.3±16.6)分，两组间差异有统计学意义(P＜0.001)。Logistic回归分析得出影响CRRT患者预后的危险因素依次为机械通气(P=0.000)、高胆红素血症(P=0.022)和低血压(P=0.030)。结论 CRRT患者的转归与APACHE高度相关，死亡与存活患者的评分存在显著差异，可用于早期预测患者的病死率。

【Abstract】Objective To analyze the APACHE score and risk factors in patients under continuous renal replacement therapy (CRRT), and to investigate the clinical application of acute physiology and chronic health evaluation (APACHE) scoring in CRRT patients. Subjects and method We studied the severe patients under CRRT in the departments of Shanghai Ruijin Hospital Affiliated to Shanghai JiaoTong University, School of Medicine in 2006. Their APACHE II and III scores were calculated 24 hours before CRRT, and their coefficient of mortality risk was also estimated. SPSS 15.0 was used for statistics. Measurement data was showed as X±S, Chi-square test was used for the comparison of ratios, and one sample t-test was used to compare the data among different groups. P<0.05 was considered to be significant. Multinomial logistic regression was applied to explore the risk factors. Results A total of 113 severe patients under CRRT were collected. Their age ranged 60.42±17.44 yrs, and the male to female ratio was 74/39. Forty-seven patients were treated in ICU, and 66 were treated outside ICU. Forty-seven cases survived, and the mortality rate was 58.4%. The average APACHE II score was 26.3±7.7, and the coefficient of mortality risk was 0.47±0.26. The APACHE II score was 29.2±8.1 and 22.4±4.8 (P<0.001) in death and survival groups, respectively. The average APACHE III score was 91.4±29.0, and the coefficient of mortality risk was 0.77±0.27. The APACHE III score was 104.7±28.6 and 72.3±16.6 (P<0.001) in death and survival groups, respectively. Logistic regression analysis showed that mechanical ventilation (P=0.000), hyperbilirubinemia (P=0.022) and hypotension (P=0.030) were the risk factors affecting the prognosis of CRRT patients. Conclusion The prognosis of CRRT patients was closely correlated to APACHE score, and the score was significantly different between death and survival groups. APACHE scoring can be applied to predict mortality of CRRT patients earlier.