摘要
目的探讨不同时期行高容量血液滤过(HVHF)对严重创伤并发多器官功能障碍综合征(MODS)预后的影响。方法将2006年1月～2011年1月行HVHF治疗的72例严重创伤并发MODS的患者分为对照组35例和治疗组37例,对照组采用一般治疗的方法,治疗组采用HVHD的方法。再用AKIN标准将治疗组分为A组(AKI 1期)、B组(AKI 2期)、C组(AKI 3期),观察对照组和治疗组30 d时的病死率;观察两组入组时和治疗24 h后的APACHEⅡ评分、SOFA评分、血浆IL-6、氧合指数、血肌酐(Cr)变化情况。结果 (1)治疗组30 d的病死率低于对照组(46%vs 71%,P<0.05)。(2)入组24 h后治疗组的APACHEⅡ评分、SOFA评分、IL-6、Cr均低于对照组,氧合指数高于对照组(P<0.05)。(3)A、B、C 3组治疗后的APACHEⅡ评分、SOFA评分、IL-6、Cr均下降,氧合指数升高,AKI分期越早越明显。结论 HVHF能有效辅助治疗严重创伤并发MODS;AKIN标准及IL-6对判断预后有指导意义;早期(AKI 1期和2期)行HVHF可明显改善严重创伤并发MODS的预后,而AKI 1期行HVHF的疗效更好。
Objective To investigate prognostic effects of high - volume hemofiltration （HVHF） at different phases of acute kidney injury（AKI） on severe trauma complicated with multiple organ dysfunction syndrome （MODS）. Methods Clinical data of 72 patients with severe trauma complicated with MODS receiving HVHF from January 2006 to January 2011 were retrospectively studied. They were divided into control group（ n = 35 ）and treatment group（ n = 37 ）. Patients in control group were treated by common therapies, while those in treatment group received HVHF. According to acute kidney injury network （AKIN） criteria, treatment group was divided into three subgroups ： group A （ AKI of phase 1 ）, group B （ AKI of phase 2 ） and group C （ AKI of phase 3 ）. The mortality rate in treatment group and control group within 30 d were calculated. Acute physiological and chronic health estimation Ⅱ （APACHE Ⅱ ） score, sequential organ failure assessment （SOFA） score, plasma interleukin - 6 （ IL - 6 ）, oxygenation index, serum creatinine were compared between the two groups when they were included into the corresponding group and 24 h later. Results （ 1 ） The mortality rate within 30 d in treatment group was lower than that in control group （46% versus 71%, P 〈 0. 05 ）. （2）24 h after enrollment in the group, APACHE Ⅱ score, SOFA score, IL - 6 and serum creatinine were lower but oxygenation index was higher in treatment group than those in control group （ P 〈0. 05 ）. （ 3 ） 24 h after enrollment in the group, APACHE Ⅱ score, SOFA score, IL - 6 and serum creatinine in group A, B and C all decreased, while oxyygenation index all increased. This phenomenon was more obvious at earlier AKI phase. Conclusion HVHF is an effective measure to treat severe trauma complicated with MODS. AKIN criteria and IL - 6 are useful for prognostic prediction. HVHF can remarkably improve the prognosis of patients with AKI of phase 1 and 2 after severe trauma complicated with MODS. Moreover, HVHF at AKI of phase 1 achieves better therapeutic effects than that of phase 2.
出处
《西南国防医药》
CAS
2011年第7期701-704,共4页
Medical Journal of National Defending Forces in Southwest China
基金
四川省卫生厅科研课题(060018)
关键词
高容量血液滤过
创伤
多器官功能障碍综合征
预后
AKI
high - volume hemofiltration
trauma
multiple organ dysfunction syndrome
prognosis
acute kidney injury
