| 摘要: |
| 目的分析以连续性静脉-静脉血液滤过(CVVH)治疗RIFLE标准不同分期的蜂蛰伤并发多器官功能障碍综合征(MODS)患者的疗效,寻找最佳治疗时机。 方法回顾性分析成都军区总医院、第三军医大学西南医院和新桥医院2006年以来收治的61例蜂蛰伤并发MODS患者资料,其中16例未行CVVH治疗,设为对照组；另外45例采用RIFLE标准的急性肾损伤(AKI)分期,按CVVH治疗时机分A组(AKI Ⅰ期开始CVVH治疗)、B组(AKI Ⅱ期开始CVVH治疗)、C组(AKI Ⅲ期开始CVVH治疗),严格按标准CVVH治疗。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以及蜂蛰伤至开始CVVH治疗的间隔时间,并将CVVH治疗前和治疗24 h后的APACHE Ⅱ评分、SOFA评分、血IL-6、氧合指数、血肌酐(Cr)、平均动脉压(MAP)等结果进行比较。结果(1)对照组的死亡率明显高于行CVVH治疗组(P<0.01)。(2)C组CVVH治疗前APACHE Ⅱ评分、SOFA评分、血IL-6、死亡率以及蜂蛰伤至开始CVVH治疗的间隔时间均明显高于A、B两组(P<0.05)。(3)A、B两组死亡率及CVVH治疗前APACHE Ⅱ评分、SOFA评分差异无统计学意义,但B组CVVH治疗前IL-6浓度明显高于A组(P<0.05),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以及蜂蛰伤至开始CVVH治疗的间隔时间明显长于A组(P<0.01)。(4)A、B、C三组CVVH治疗24 h后血IL-6、氧合指数、Cr、MAP均明显改善(P<0.01),但C组IL-6仍高于A、B两组(P<0.05)；A、B两组CVVH治疗24 h后APACHE Ⅱ评分、SOFA评分降低(P<0.01),C组治疗24 h后与治疗前相比差异无统计学意义。结论CVVH是治疗蜂蛰伤并发MODS的一种有效手段,RIFLE标准对判断CVVH的治疗时机有指导意义,AKI Ⅰ期和Ⅱ期行CVVH可明显改善蜂蛰伤并发MODS的预后,而AKI Ⅰ期行CVVH的疗效更佳。 |
| 关键词: 连续性静脉-静脉血液滤过 蜂蜇伤 多器官功能障碍综合征 RIFLE标准 细胞因子 |
| DOI：10.3724/SP.J.1008.2011.0417 |
| 投稿时间：2011-01-10修订日期：2011-03-11 |
| 基金项目:四川省卫生厅资助项目(100189,100095,100190). |
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| Timing of continuous veno-venous hemofiltration for patients with wasp sting-induced multiple organ dysfunction syndrome of different phases according to RIFLE criteria |
| DING Sheng1,ZHANG Yu-hua1,ZHANG Jin-bao2*,JIANG Li1,YIN Chang-lin3,ZHOU Ren-jie4 |
| (1. Department of Intensive Care Unit, General Hospital, PLA Chengdu Military Area Command, Chengdu 610083, Sichuan, China;2. Department of Cardiovascular Surgery, General Hospital, PLA Chengdu Military Area Command, Chengdu 610083, Sichuan, China;3. Department of Emergency, Southwest Hospital, Third Military Medical University, Chongqing 400038, China;4. Department of Emergency, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China) |
| Abstract: |
| ObjectiveTo analyze the efficacy of continuous veno-venous hemofiltration (CVVH) for patients with wasp sting-induced multiple organ dysfunction syndrome(MODS)at different phases according to RIFLE criteria. MethodsThe clinical data of 61 patients with wasp sting-induced MODS, who were treated in Chengdu General Hospital, Southwest Hospital and Xinqiao Hospital during Jan.2006 to Dec.2010, were retrospectively analyzed. Sixteen patients who were not treated with CVVH were taken as controls. Another 45 patients with acute kidney injury(AKI) were divided into 3 groups: group A (AKI Ⅰ), group B(AKI Ⅱ) and group C (AKI Ⅲ)according to the RIFLE criteria; the timing of CVVH was analyzed according to different phases of AKI. The mortality rate in hospital, length of ICU stay, duration of total mechanical ventilation, length of CVVH, and the intervals between wasp sting and CVVH were compared among different groups. Their APACHE Ⅱ scores, sequential organ failure assessment(SOFA) scores, serum interleukin-6(IL-6), oxygenate index, serum creatinine(Cr), and mean arterial pressure(MAP) were compared before and 24 h after CVVH. Results(1)The mortality rate in the control group was significantly higher than that in therapeutic group(P<0.01).(2)Before CVVH, APACHE Ⅱ score, SOFA score, serum IL-6, the mortality rate and the interval between wasp sting and CVVH were significantly higher or longer in group C compared with those in group A and B (P<0.05). (3)The APACHE Ⅱ score, SOFA score and the mortality rate of group A and B were similar before CVVH(P＞0.05),but serum IL-6 in group B was significantly higher than that in group A(P<0.05). The length of ICU stay, duration of total mechanical ventilation, duration of CVVH and the interval between wasp sting and CVVH in group B were significantly longer than those in group A (P<0.01).(4)After 24 h CVVH, the serum IL-6, oxygenate index, Cr and MAP were significantly improved in all the 3 groups(P<0.01),but the serum IL-6 in group C was still significantly higher than those in group A and B (P<0.05). The APACHE Ⅱ score and SOFA score were significantly decreased in group A and B after 24 h CVVH, but they had no significant change in group C (P＞0.05). ConclusionCVVH is an effective treatment for patients with wasp sting-induced MODS.RIFLE criteria can help to guide the timing of CVVH.CVVH can remarkably improve the prognosis of patients with phaseⅠand Ⅱ AKI after wasp sting-induced MODS, with the best efficacy seen in patient with phase Ⅰ AKI. |
| Key words: continuous veno-venous hemofiltration wasp stings multiple organ dysfunction syndrome RIFLE criteria cytokine |
