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目的探讨RIFLE标准在外科术后急性肾损伤(AKI)患者选择肾替代治疗时机选择中的作用及与预后的关系。方法回顾性分析2001年1月至2006年12月第四军医大学第一附属医院行肾脏替代治疗的外科术后AKI患者368例,按治疗方式分为两组:(1)连续性静脉-静脉血液滤过(CVVH)组,316例,每日置换总量48～96 L;(2)非CVVH组,52例,其中间断性血液透析(IHD)29例,每日或隔日治疗4.5 h;腹膜透析(PD)23例,每日腹透液总量8～12L。应用RIFLE标准对AKI进行分期,对比分析各组患者在不同AKI分期的医院死亡率、APACHEⅡ评分、器官衰竭数,以及CVVH组存活者的CWH治疗时间、尿量恢复时间和ICU逗留时间等指标的区别。结果(1)AKIⅢ期患者医院死亡率高于AKIⅠ期和Ⅱ期患者(P<0.05)。(2)CVVH患者治疗前APACHEⅡ评分在AKI的3个分期中均高于IHD/PD患者(P<0.05)。(3)CVVH存活者的CWH治疗时间、尿量恢复时间和ICU逗留时间随AKI分期的加重而延长。结论RILFE标准对外科术后AKI早期诊断和判断预后有指导意义。必须强调肾脏替代时机的选择,早期行肾替代治疗(AKIⅠ期和Ⅱ期)可以明显改善预后,而CVVH比IHD和PD更有优势。
Objective To investigate the role of RIFLE in the timing of choice of renal replacement therapy in patients with acute renal injury (AKI) and its relationship with prognosis. Methods A retrospective analysis of 368 surgical AKI patients undergoing renal replacement therapy at the First Affiliated Hospital of the Fourth Military Medical University from January 2001 to December 2006 was divided into two groups according to the mode of treatment: (1) continuous veno-venous (2) Non-CVVH group, 52 cases, including intermittent hemodialysis (IHD) in 29 cases, daily or every other day treatment 4.5 h; Peritoneal dialysis (PD) in 23 cases, the daily total amount of dialysate 8 ~ 12L. The RIFLE criteria were used to stage AKI. The hospital mortality, APACHEⅡscore, the number of organ failure and the CWH treatment time, urine output recovery time and ICU stay time in different AKI staging groups were analyzed. the difference. Results (1) The hospital mortality in patients with AKI stage Ⅲ was higher than that in stage Ⅰ and Ⅱ AKI patients (P <0.05). (2) The APACHEⅡscore of CVVH patients before treatment was higher than that of IHD / PD patients in three stages of AKI (P <0.05). (3) CWH treatment time, urine output recovery time and ICU stay in CVVH survivors were prolonged with the aggravation of AKI staging. Conclusion The RILFE standard is of guiding significance for the early diagnosis and prognosis of AKI after surgery. Must emphasize the timing of renal replacement, early renal replacement therapy (AKI Ⅰ and Ⅱ) can significantly improve the prognosis, and CVVH more advantages than IHD and PD.