ABSTRACT
Objective To evaluate the different methods of blood purification for acute septic renal injury (AKI) in respect of outcome by using RIFLE(risk,injury,failure,loss and end-stage renal disease)criteria and A-PACHE Ⅱ score. MethodData of 96 patients with ASRI admired to ICU of Tianhe Hospital, Tianjin, from March 2004 to September 2006 were analyzed. Including criteria: 2001 International Sepsis Definitions Conference and 2004 RIFLE criteria of AKI. The methods of blood purification used continuous renal replacement therapy (CRRT, n=54) and imermittent hemodialysis (IHD, n=42).The patients of CRRT group could be classified into stages Ⅰ, Ⅱ and Ⅲ referred to RIFLE criteria. Excel was evaluated to set up clinical data base from documented material. Data were analyzed with SPSS version 11. 5 software. Physical signs, laboratory findings, variation of APACHE Ⅱ score and outcomes of patients were documented evaluated. Data of two groups compared using indepent samples T test, before and after the treatment compared using paired-samples T test, rate compared using chi-square test. Results①There were no statistical differences in APACHE Ⅱ score and creatinine (Cr) between CRRT group and IHD group before treatment (P>0.05). The mortalities of CRRT group and IHD group were 51.9％ and 52.4％, respectively (P>0.05), but the recovery rates of renal function in CRRT group and IHD group were 92.3％ and 65.0％ ,respectively (P< 0.05).②Mean arterial pressure (MAP),oxygen saturation (SpO2) of CRRT group were lower than those of IHD group (P<0.05) and they increased to some extent after treatment (P< 0.05). ③In the patients of stag Ⅰ ,the survival rate was 78.6％, APACHE Ⅱ score was 25.4± 2.5 before treatment, renal function recovery rate was 90.9％ ,and APACHE Ⅱ changed - 13.6 ± 4.3, while those relevant markers in the patients of stage Ⅲ were 38.1％, 36.1 ± 5.7,62.5 ％ and - 7.1 ± 4.2, respectively (P<0.05). ConclusionsThe RIFLE criteria has guiding significance for the early diagnosis and prognosis of ASRI,and the RIFLE and APACHE Ⅲ score may help to choose the optimum opportunity of treatment and the early CRRT as soon as possible after diagnosis can improve the outcome of patients with acute septic renal injury.