【摘要】 目的:探讨合并有急性肾损伤(AKI)的多器官功能障碍综合征(MODS)患者早期行高容量血液滤过(HVHF)治疗后对器官保护作用。方法:选择重症监护室于2008年6-2012年1月收治的MODS合并AKI并接受HVHF治疗的患者86例作为研究对象。根据RIFLE分级分为Risk组10例,Injury组17例,Failure组59例。记录患者HVHF治疗前后血肌酐(SCr)、氧合指数(PaO2/FiO2)、血管外肺水指数(EVLWI)、动脉血乳酸(Lac)、凝血酶原时间(PT)、天冬氨酸转氨酶(AST)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分以及28天存活率。结果:HVHF治疗后,Failure组SCr、EVLWI、Lac、PT、AST、APACHEII评分均显著高于Risk组和Injury组,PaO2/FiO2显著低于Risk组和Injury组,差异有统计学意义(P<0.05)。Risk组和Injury组在HVHF治疗后各指标差异均无统计学意义(P>0.05)。Risk组28天存活率为60.0%,Injury组64.71%,Failure组存活率为66.10%,3组间差异均无统计学意义(P>0.05)。结论:早期HVHF治疗对MODS合并AKI患者的器官具有保护作用,值得临床进一步研究。更多还原

【Abstract】 Objective: To investigate the efficiency of early high volume hemofiltration(HVHF) to patients with multiple organ dysfunction syndrome(MODS) combined with acute kidney injury(AKI).Methods: 86 patients with MODS combined with AKI and treated by HVHF in our hospital were involved into this study during June 2008-January 2012.They were divided into the Risk group with 10 cases,Injury group with 17 cases,and Failure group with 59 cases according to RIFLE.Serum creatinine(SCr),oxygenation index(PaO2/FiO2),extravascular lung water index(EVLWI),lactate(Lac),prothrombin time(PT),aspartate aminotransferase(AST),Acute Physiology And Chronic Health Evaluation System II(APACHE II) and 28-day survival rate before and after HVHF treatment were recorded.Results: SCr,EVLWI,Lac,PT,AST,APACHEII in the Failure group were significantly higher than those in the Risk group and Injury group after HVHF treatment.PaO2/FiO2 in the Failure group was significantly lower than the Risk Group and Injury group.The differences were statistically significant(P<0.05).The differences of indexes in the Risk Group and Injury group after HVHF treatment were not statistically significant the(P>0.05).The 28-day survival rate in the Risk Group was 60.0%.It was 64.71% in the Injury group,and 62.71% in the Failure group.The differences among the three groups were not statistically significant(P>0.05).Conclusions: HVHF treatment was effective to protect the organs of patients with early MODS combined with AKI.It was suggested to take further clinical studies.更多还原