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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。
Objective To investigate the timing and the effect of RIFLE on the prognosis of sepsis complicated with multiple organ dysfunction syndrome (MODS) in patients with high-volume hemofiltration (HVHF). Methods Fifty-two patients with sepsis complicated with MODS treated with HVHF from January 2006 to December 2010 in Chengdu Military General Hospital were retrospectively analyzed. The patients were divided into two groups according to RIFLE criteria: group A (AKIⅠ), group B (AKIⅡ) and group C (AKI Ⅲ). The mortality, ICU stay, mean duration of mechanical ventilation and mean duration of continuous hemofiltration in each group were compared. The APACHE Ⅱ score, SOFA score, plasma interleukin IL-6, oxygenation index, serum creatinine (Scr) and mean arterial pressure (MAP). Results (1) APACHEⅡscore, SOFA score, plasma IL-6 and mortality in group C were significantly higher than those in group A and B before HVHF treatment (P <0.01); (2) APACHEⅡscore, SOFA (P> 0.05). However, the mean duration of hospital stay, mean duration of mechanical ventilation and mean duration of continuous hemofiltration of IL-6 and mean continuous hemofiltration in group B before HVHF treatment were significantly higher than those in group A (P <0.01). (3) IL-6, oxygenation index, Scr and MAP in plasma were significantly improved after HVHF treatment for 24 h, but the level of IL-6 in group C was still higher than that in group A and B The levels of IL-6 in group A and group B were still significantly higher than those in group A (P <0.01). The APACHEⅡscore and SOFA scores in group A and group B after 24 h of HVHF treatment were significantly lower than those in group A (P <0.01). Conclusions HVHF can effectively treat sepsis complicated by MODS. RIFLE criteria and IL-6 may be helpful in judging the prognosis. HVHF in early stages (stage I and stage AKI) can significantly improve the prognosis of sepsis complicated with MODS. Stage I The effect of HVHF is better.