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目的:探讨不同肾功能损害时期行高容量血液滤过(HVHF)治疗对多器官功能障碍综合征(MODS)疗效的影响。方法:采用RIFLE标准,将入选的MODS患者按急性肾损伤(AKI)分为AKIⅠ期(A组)、AKIⅡ期(B组)、AKIⅢ期(C组),以不同AKI分期作为HVHF治疗的时机,对比分析不同时期行HVHF治疗MODS患者的死亡率、平均重症监护病房(JCU)院时间(T1)、平均机械通气时间(T2)、平均连续血液滤过治疗时间(T3),并将HVHF治疗前和治疗24h后的APACHEⅡ评分、SOFA评分、血浆白介素-6(IL-6)、氧合指数、血浆肌酐(Cr)、平均动脉压(MAP)等结果进行比较。结果:1、AKIⅢ期患者死亡率显著高于AKⅡ期和AKIⅡ期患者(P<0.01);AKIⅡ期患者T1、T2和T3显著高于AKIⅠ期患者(P<0.01);2、与AKIⅠ期和AKIⅡ期患者比较,AKIⅢ期患者HVHF治疗前APACHEⅡ评分、SOFA评分、IL-6和Cr均显著增高(P<0.05);AKIⅡ期患者HVHF治疗前血浆IL-6显著高于AKIⅠ期患者(P<0.01);3、与HVHF治疗前比较,三组患者HVHF治疗24 h后IL-6、氧合指数、Cr和MAP均显著改善(P<0.01);AKIⅢ期患者治疗后的IL-6仍显著高于AKIⅠ期和AKIⅡ期患者;AKIⅠ期和AKIⅡ期患者HVHF治疗24h后APACHEⅡ评分、SOFA评分显著降低(P<0.01),AKIⅢ期患者治疗前后APACHEⅡ评分和SOFA评分变化无显著统计学差异。结论:RIFLE标准及IL-6对判断预后有指导意义;AKIⅠ期和Ⅱ期行HVHF可明显改善MODS的预后,而AKI I期行HVHF的疗效更好。
Objective: To investigate the effect of high-volume hemofiltration (HVHF) on the treatment of multiple organ dysfunction syndrome (MODS) in different stages of renal dysfunction. Methods: According to RIFLE criteria, the patients with MODS were divided into two groups according to their acute kidney injury (AKI): group A (AKI), group AKI (group B), group AKI (group C) The mortality rate, mean hospital stay (JC), mean mechanical ventilation time (T2) and mean duration of continuous hemofiltration (T3) in patients with MODS undergoing HVHF at different periods were compared and analyzed. HVHF treatment APACHEⅡscore, SOFA score, IL-6, oxygenation index, serum creatinine (Cr) and mean arterial pressure (MAP) before and 24 hours after treatment were compared. The mortality of patients with AKIⅢwas significantly higher than that of patients with AKⅡand AKIⅡ (P <0.01); T1, T2 and T3 were significantly higher in patients with AKIⅡ than those in AKIⅠ (P <0.01); 2, Compared with AKIⅡgroup, APACHEⅡscore, SOFA score, IL-6 and Cr were significantly increased in patients with AKI Ⅲ before HVHF treatment (P <0.05), while plasma IL-6 level before HVHF treatment in AKIⅡgroup was significantly higher than that in AKIⅠperiod (P < 0.01) .3. Compared with HVHF before treatment, the levels of IL-6, oxygenation index, Cr and MAP in three groups were significantly improved after 24 h of HVHF treatment (P <0.01) APACHEⅡscore and SOFA score were significantly lower after AKHⅠand AKIⅡhad 24h treatment (P <0.01). There was no significant difference in APACHEⅡscore and SOFA score between AKIⅢpatients before and after treatment. Conclusions: The RIFLE criteria and IL-6 have guiding significance in judging the prognosis. HVHF in stage I and II of AKI can significantly improve the prognosis of MODS, while the effect of HVHF in AKI stage I is better.