RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究

姜建青; 刘宝玉; 俞永康; 郑轶峰; 李卫; 刘小燕; 尹昌林; 张渝华

doi:10.13406/j.cnki.cyxb.2011.04.020

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RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究

临床研究 | 更新时间：2024-01-17

- RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究
- Application of RIFLE criteria in the treatment of high-volume hemofiltration for patients with severe trauma complicated with multiple organ dysfunction syndrome
- 重庆医科大学学报 2011年36卷第4期页码：479-482
- 作者机构：
  
  1. 成都军区总医院胸外科
  2. 第三军医大学西南医院急救部
  3. 成都军区总医院重症医学科
- 作者简介：
- 基金信息：
  
  四川省卫生厅资助项目（编号:100095、100189、100190）
- DOI：10.13406/j.cnki.cyxb.2011.04.020
  中图分类号： R641
- 纸质出版日期：2011，
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[1]姜建青,刘宝玉,俞永康,郑轶峰,李卫,刘小燕,尹昌林,张渝华.RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究[J].重庆医科大学学报,2011,36(04):479-482.

JIANG Jian-qin, et al. Application of RIFLE criteria in the treatment of high-volume hemofiltration for patients with severe trauma complicated with multiple organ dysfunction syndrome[J]. Journal of Chongqing Medical University, 2011,36(4):479-482.
[1]姜建青,刘宝玉,俞永康,郑轶峰,李卫,刘小燕,尹昌林,张渝华.RIFLE标准在HVHF治疗严重创伤并发MODS的应用研究[J].重庆医科大学学报,2011,36(04):479-482. DOI： 10.13406/j.cnki.cyxb.2011.04.020.

JIANG Jian-qin, et al. Application of RIFLE criteria in the treatment of high-volume hemofiltration for patients with severe trauma complicated with multiple organ dysfunction syndrome[J]. Journal of Chongqing Medical University, 2011,36(4):479-482. DOI： 10.13406/j.cnki.cyxb.2011.04.020.

摘要

目的:探讨以RIFLE标准衡量高容量血液滤过（High-volume hemofiltration

HVHF）治疗严重创伤并发多器官功能障碍综合征（Multiple organ dysfunction syndrome

MODS）的治疗时机及其对预后的影响。方法:回顾性分析成都军区总医院和西南医院自2006年以来行HVHF治疗的47例严重创伤并发MODS的患者

采用RIFLE标准

分A组（AKIⅠ期）、B组（AKIⅡ期）、C组（AKIⅢ期）

以AKI分期作为HVHF治疗的时机

对比分析各组的死亡率、平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间

并将HVHF治疗前和治疗24 h后的APACHEⅡ评分、SOFA评分、血浆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:①C组HVHF治疗前APACHEⅡ评分、SOFA评分、血浆IL-6及死亡率均明显高于A、B 2组（P<0.01）;②A、B 2组HVHF治疗前APACHEⅡ评分、SOFA评分及死亡率差异无统计学意义

但B组HVHF治疗前IL-6浓度以及平均ICU住院时间、平均机械通气时间、平均连续血液滤过治疗时间明显高于或长于A组（P<0.01）;③3组HVHF治疗24 h后血浆IL-6、氧合指数、Cr、MAP均明显改善

但C组IL-6仍高于A、B 2组（P<0.01）

B组IL-6仍高于A组（P<0.01）;A、B 2组HVHF治疗24 h后APACHEⅡ评分、SOFA评分显著降低（P<0.01）

C组变化无显著性。结论:HVHF能有效辅助治疗严重创伤并发MODS;RIFLE标准及IL-6对判断预后有指导意义;早期（AKIⅠ期和Ⅱ期）行HVHF可明显改善严重创伤并发MODS的预后

而AKIⅠ期行HVHF的疗效更好。

Abstract

Objective:To investigate the prognosis of patients with severe trauma complicated with multiple organ dysfunction syndrome(MODS) using high-volume hemofiltration(HVHF)stratified with RIFLE criteria.Methods:We retrospective studied 47 patients with severe trauma complicated with MODS from Chengdu Military General Hospital and Southwest Hospital.These patients were treated with HVHF in the period of Jan.2006 to Dec.2010.All of them were divided into three groups:group A(AKI Ⅰ)

group B(AKI Ⅱ)

and group C(AKI Ⅲ)according to the RIFLE criteria.The timing at which they received HVHF was analyzed by different phase of AKI.The mortality rate during hospital ization

length of ICU stay

duration of total mechanical ventilation

and the length of HVHF were compared among three groups.Their APACHE Ⅱ score

sequential organ failure assessment(SOFA)score

serum interleukin-6(IL-6)

oxygenate index

serum creatinine

mean arterial pressure(MAP)were also compared before and 24 hours after HVHF.Results:①Before HVHF

APACHE Ⅱ score

SOFA score

serum IL-6

and the mortality rate were higher in patients with AKI of phase Ⅲ than those with AKI of phase Ⅰand Ⅱ(P<0.01).②Before HVHF

APACHE Ⅱ score

SOFA score

and the mortality rate in patients with AKI of phase Ⅰand Ⅱ were insignificant(P>0.05)

but serum IL-6 before HVHF and ICU length of stay

duration of total mechanical ventilation

the length of HVHF in patients with AKI of phase Ⅱ were higher or longer than those with AKI of phase Ⅰ(P<0.01).③24 hours after HVHF

serum IL-6

oxygenate index

serum creatinine and MAP improved significantly in all patients(P<0.01)

but serum IL-6 in patients with AKI of phase Ⅲ was still higher than those with AKI of phase Ⅰand Ⅱ

serum IL-6 in patients with AKI of phase Ⅱwas still higher than those with AKI of phaseⅠ.APACHE Ⅱ score and SOFA score decreased significantly in patients with AKI of phase Ⅰand Ⅱ(P<0.01)

but insignificantly in those with AKI of phase Ⅲ(P>0.05).Conclusion:HVHF is an effective measure for patients with severe trauma complicated with MODS.RIFLE criteria and IL-6 are useful for the prognosis prediction.HVHF remarkably improves the prognosis of patients with AKI of phase Ⅰand Ⅱ after severe trauma complicated with MODS.Therapeutic effect on patients with severe trauma complicated with MODS is better when HVHF starts in the phase of AKI Ⅰ.

关键词

高容量血液滤过创伤多器官功能障碍综合征RIFLE标准细胞因子

Keywords

high-volume hemofiltration(HVHF)traumamultiple organ dysfunction syndrome(MODS)RIFLE criteriacytokine

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