CAJ | 학술논문

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-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AKI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KDIGO 1、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,KDIGO 1、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KDIGO 1、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KDIGO 3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KDIGO 1、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KDIGO 1、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.
목적 탐토급성신손상(AKI)분기대다기관공능장애종합정(MODS)반AKI환자선택련속성혈액정화(CBP)치료개입시궤적지도의의.방법 채용회고성연구방법,선택126례종합중증감호병방(ICU)화급진중증감호병방(EICU)수치적MODS반AKI수행련속성정-정맥혈액려과치료적환자,분별채용개선전구신병예후조직적AKI분기표준(KDIGO표준)화급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분분위KDIGO 1、2、3기조화APACHEⅡ평분＜15분、15～ 25분、＞25분조；대각아조간ICU적주원존활솔급존활환자신공능전귀、CBP치료초려총량、ICU내평균주원시간화의료비용진행비교.결과 여APACHEⅡ≤25분환자상비,KDIGO 1、2기환자적주원존활솔명현증고[94.1％(32/34)비76.8％(43/56),P＜ 0.05],차KDIGO 1、2기존활환자신공능개선솔야현저증고[90.6％(29/32)비62.8(27/43),P＜0.05],CBP치료초려총량、ICU내평균주원시간、의료비용균현저감저[CBP치료초려총량(L):199.0±44.7비239.0±73.3,ICU평균주원시간(d):12.9±3.4비15.1±4.8,의료비용(만원):2.6±0.4비3.0±1.0,균P＜0.05].이KDIGO 3기존활환자여APACHEⅡ＞25분자상술지표비교균무현저차이,차각지표균차우KDIGO 1、2기자화APACHEⅡ평분≤25분자.결론 MODS반AKI시,여APACHEⅡ평분≤25분시개시CBP치료상비,재KDIGO 1、2기시급여CBP치료,불단가이제고환자생존솔、개선생존환자신공능,이차가감소ICU주원시간화의료비용.
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 hemofiltration 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 ultrafiltration,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 ultrafiltratian (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 Ⅱ 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.