脓毒症导致急性肾损伤血液净化方式和时机的选择

›› 2009, Vol. 8 ›› Issue (2): 62-66.

脓毒症导致急性肾损伤血液净化方式和时机的选择

李家瑞王永明武子霞王浩王庆树张红燕由希雷乔佑杰

天津市天和医院急救医学科

收稿日期:2008-07-02 修回日期:1900-01-01 出版日期:2009-02-12 发布日期:2009-02-12

The appropriate period and blood purification method for the treatment of acute kidney injury caused by sepsis

LI Jia-rui, WANG Yong-ming, WU Zi-xia, WANG Hao, WANG Qing-shu, ZHANG Hong-yan, YOU Xi-lei, QIAO You-jie.

ICU, Tianhe Hospital, Tianjin 300050, China

Received:2008-07-02 Revised:1900-01-01 Online:2009-02-12 Published:2009-02-12

摘要/Abstract

摘要： 【摘要】目的探讨运用AKI的 RIFLE标准和APACHEⅡ评分选择脓毒症导致急性肾损伤的血液净化方式和时机。方法回顾性分析2004年3月～2006年9月收住于天津市天和医院ICU的96例脓毒症导致AKI的患者；依据血液净化方式分为CRRT组(54例)和IHD组(42例)，将CRRT组参照RIFLE标准分为Ⅰ期（14例）、Ⅱ期(19例)、Ⅲ期（21例）；评价患者生命体征、实验室指标、APACHE II评分动态变化和患者的不同预后。结果 ①CRRT组与IHD组治疗前APACHE Ⅱ评分、肌酐差异没有统计学意义(P ＞0.05)，治疗结束后CRRT组患者APACHE Ⅱ评分低于IHD组患者；CRRT组患者平均动脉压、血氧饱和度较IHD组低（P＜0.05），治疗后MAP、SpO2有所上升(P＜0.05)；②CRRT组与IHD组病死率分别为51.9%和52.4%（P＞0.05)，而肾功能恢复率分别为92.3% 与65.0% (P＜0.05）；③CRRT组中Ⅰ期患者存活率78.6%、治疗前APACHE II评分(25.4±2.5)、肾功能恢复率90.9%、APACHE II变化(-13.6±4.3)，而Ⅲ期患者上诉指标分别为38.1%、(36.1±5.7)、62.5%、(-7.1±4.2)，差异有统计学意义(P＜0.05)。结论运用AKI的RIFLE诊断标准结合APACHEⅡ评分选择合适的治疗时机，采用CRRT是防治脓毒症导致急性肾损伤的有效手段。

关键词: 连续性肾脏替代治疗, 间歇性血液透析, 脓毒症, 急性肾损伤

Abstract: 【Abstract】 Objective To evaluate the appropriate period and blood purification method for the treatment of sepsis-induced acute kidney injury by using Risk, Injury, Failure, Loss, and End-stage Kidney Classification for acute kidney injury (RIFLE criteria for AKI) and APACHE II score. Methods We retrospectively analyzed 96 sepsis-induced acute kidney injury patients treated in the ICU of Tianjin Tianhe Hospital during the period from March 2004 through September 2006. They were assigned in the continuous renal replacement therapy (CRRT) group (54 cases) or the intermittent hemodialysis (IHD) group (42 cases). In the CRRT group, patients were evaluated by RIFLE criteria for AKI, from which 14 cases were at stage I, 19 cases at stage II, and 21 cases at stage III. Their vital signs, laboratory parameters, dynamic change of APACHE II score and prognosis were observed. Results ①Before the treatment, there were no differences in APACHE II score and serum creatinine level between the two groups (P>0.05). After the treatment, APACHE II score, mean arterial pressure and oxygen saturation rate were lower in the CRRT group than in the IHD group (P<0.05). The lowered mean arterial pressure and oxygen saturation rate improved after the treatment (P<0.05). ②The mortality rate was 51.9% and 52.4% (P>0.05), and the recovery rate of renal function was 92.3% and 65.0% (P<0.05), in the CRRT group and the IHD group, respectively. ③ In the CRRT group, the survival rate was 78.6% and 38.1%, APACHE II score before the treatment was 25.4±2.5 and 36.1±5.7, recovery rate of renal function was 90.9% and 62.5%, the range of APACHE II score change was -13.6±4.3 and -7.1±4.2, in patients at stage I and stage III, respectively. These differences were statistically significant (P<0.05). Conclusion RIFLE criteria of AKI in association with APACHE II score are useful to estimate the appropriate time for blood purification. CRRT is an effective method to prevent and treat sepsis-induced acute kidney injury.

Key words: Intermittent hemodialysis, Sepsis, Acute kidney injury

李家瑞王永明武子霞王浩王庆树张红燕由希雷乔佑杰. 脓毒症导致急性肾损伤血液净化方式和时机的选择[J]. , 2009, 8(2): 62-66.

LI Jia-rui;WANG Yong-ming;WU Zi-xia;WANG Hao;WANG Qing-shu;ZHANG Hong-yan;YOU Xi-lei;QIAO You-jie.. The appropriate period and blood purification method for the treatment of acute kidney injury caused by sepsis[J]. , 2009, 8(2): 62-66.