摘要
【摘要】目的探讨急性肾损伤（AKI）分期对多器官功能障碍综合征（MODS）伴AKI患者选择连续性血液净化（CBP）治疗介入时机的指导意义。方法采用回顾性研究方法，选择126例综合重症监护病房（ICU）和急诊重症监护病房（EICU）收治的MODS伴AKI需行连续性静一静脉血液滤过治疗的患者，分别采用改善全球肾病预后组织的AK1分期标准（KDIGO标准）和急性生理学与慢性健康状况评分系统II（APACHEII）评分分为KDIGO1、2、3期组和APACHEⅡ评分〈15分、15—25分、〉25分组；对各亚组间ICU的住院存活率及存活患者肾功能转归、CBP治疗超滤总量、ICU内平均住院时间和医疗费用进行比较。结果与APACHEⅡ≤25分患者相比，KDIGOl、2期患者的住院存活率明显增高（94．1％（32／34）比76．8％（43／56），P〈0．05]，且KDIGO1、2期存活患者肾功能改善率也显著增高[90．6％（29／32）比62．8（27／43），P〈0．05]，CBP治疗超滤总量、ICU内平均住院时间、医疗费用均显著减低[CBP治疗超滤总量（L）：199．0±44．7比239．0±73．3，ICU平均住院时间（d）：12．9±3．4比15．1±4．8，医疗费用（万元）：2．6±0．4比3．0±1．0，均P〈0．05]。而KDIGO3期存活患者与APACHEII〉25分者上述指标比较均无显著差异，且各指标均差于KDIGO1、2期者和APACHEⅡ评分≤25分者。结论MODS伴AKI时，与APACHEII评分≤25分时开始CBP治疗相比，在KDIGO1、2期时给予CBP治疗，不但可以提高患者生存率、改善生存患者肾功能，而且可减少ICU住院时间和医疗费用。
Objective To investigate the role of acute kidney injury staging in multiple organ dysfunction syndrome （MODS） patients with acute kidney injury （AKI） for deciding the opportune time of continuous blood purification （CBP）. Methods A retrospective study was conducted. One hundred and twenty-six MODS patients with AKI in general intensive care unit （ICU） and emergency intensive care unit （EICU） requiring continuous venous-venous hemofihration treatment were enrolled. According to the criteria of Kidney Disease： Improving Global Outcomes Organizaation （KDIGO standard） and acute physiology and chronic health evaluation II （APACHE II ） score, the patients were stratified into KDIGO 1, 2, 3 groups and APACHE II score of 〈 15, 15-25, 〉25 groups. ICU survival rate and renal function outcome, CBP treatment total uhrafiltration, average ICU day and the average medical costs of survivals were compared among groups. Results Compared with APACHE II ≤ 25, KDIGO 1, 2 hospitalized patients had significantly higher survival rate [94.1% （32/34） vs. 76.8% （43/56）, P〈0.05]. Renal function improvement rate in survivors of KDIGO 1, 2 patients was significantly higher than that in APACHE II ≤ 25 （90.6% （29/32） vs. 62.8 （27/43）, P〈0.01], and number of patients requiring CBP treatment, mean ICU day, and medical expenses were significantly reduced（CBP treatment of total uhrafiltration （L） ： 199.0±44.7 vs. 239.0 ± 73.3, the mean length of stay in ICU （d）： 12.9 ± 3.4 vs. 15.1 ± 4.8, medical expenses （million）： 2.6 ±0.4 vs. 3.0 ± 1.0, all P〈 0.05 ]. There was no significant difference in above indexes between survivors in KDIGO 3 and APACHE Ⅱ 〉25, and the indexes in KDIGO 3 and APACHE II 〉25 were worse than those in KDIGD 1, 2 and APACHE Ⅱ〉25. Conclusion In patients of MODS accompanied by AKI, compared using as APACHE 1] score ≤ 25 as opportune time to start CBP, to commence the treatment in the period of KDIGO standard 1, 2 cannot only improve patient survival with recovery of renal function, but also can reduce the ICU stay and medical expenses.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第7期420-423,共4页
Chinese Critical Care Medicine
基金
河北省承德市科学技术研究与发展计划项目（20123103）
