摘要
目的:探讨急性生理学及慢性健康状况评分系统(APACHE)在急性肾衰竭肾替代治疗中的应用。方法:收集我院2007年2月～2010年10月进行持续低效血液透析法(SLED)治疗的重症急性肾功能衰竭88例,于SLED前24h内计算APACHEⅢ,并估算患者的死亡风险系数。结果:88例患者存活60例,死亡28例,平均年龄(61.1±16.8)岁;死亡组使用SLED主要为少尿、酸碱失衡、电解质紊乱和SIRS,而存活组中以水负荷过重和肌酐升高为主;88例急性肾衰竭患者APACHEⅢ均值为(90.8±28.7)分,风险系数为(0.68±0.31);死亡组均值为(112.3±26.5)分和存活组均值为(75.7±15.9)分,差异有高度统计学意义(t=6.75,P<0.001);APACHEⅢ>50分时,死亡风险为60.2%;>70分时病死率为90.0%;经统计学检验,影响SLED患者预后的危险因素为机械通气(P=0.001)、低血压(P=0.025)和高胆红素血症(P=0.029)。结论:实行SLED的急性肾衰竭死亡者与存活者的APACHEⅢ评分存在显著差异,APACHEⅢ评分可用于评价实施SLED的ARF患者的死亡风险。
Objective： To analyze the clinical application of acute physiology and chronic health evaluation（APACHE） scoring in acute renal failure（ARF） patients under sustained low-efficiency dialysis（SLED）.Methods： We studied 88 ARF patients under SLED in our hospital in the year from February 2007 to October 2010.We calculated the APACHEIII scores before SLED in 24 hours,and estimated their coefficient of mortality risk also.Results： We collected a total of 88 ARF patients under SLED.Their age ranged（61.1±16.8） years,60 patients were suivial,and 28 patients were died.The death groups used SLED for oliguria,acid-base unbalance,electrolyte disturbance and SIRS,while the survival groups for water load and creatinine increase.The average APACHEIII score was（90.8±28.7）,and the coefficient of mortality risk was（0.68±0.31）.The APACHEIII score in death and survival groups was（112.3±26.5） and（75.7±15.9） respectively（t=6.75,P0.001）.The risk of death was 60.2% when the APACHEIII score was 50,and the fatality was 90.0% when the APACHEIII score was 70.It showed that hyperbilirubinemia（P=0.029）,mechanical ventilation（P=0.001） and hypotension（P=0.025）were the risk factors affecting the prognosis of SLED patients by statistical tests.Conclusion： The prognosis of SLED patients is closely correlated to.The APACHEⅢ score between the group of died patients and survival patients under SLED was siginificant differences,APACHEⅢ scoring can be applied to predict mortality of ARF patients under SLED.
出处
《中国医药导报》
CAS
2011年第16期187-189,共3页
China Medical Herald
