ĐÁNH GIÁ HIỆU QUẢ LỌC MÁU LIÊN TỤC TRONG ĐIỀU TRỊ SUY ĐA TẠNG DO SỐC NHIỄM KHUẨN TẠI KHOA HỒI SỨC TÍCH CỰC BỆNH VIỆN ĐA KHOA TỈNH HÀ TĨNH

Abstract

Objectives: To describe the clinical and laboratory characteristics and to evaluate the effectiveness of continuous renal replacement therapy (CRRT) in the treatment of multiple organ failure (MOF) caused by septic shock. Subjects: The study included 46 patients diagnosed with multiple organ failure (MOF) due to septic shock who received continuous renal replacement therapy (CRRT) at the Intensive Care Unit (ICU) of Ha Tinh General Hospital from October 2021 to September 2024. Results: The mean age of the patients was 66.1 ± 15.9 years. Common comorbidities included cardiovascular disease (37%) and chronic obstructive pulmonary disease (30.4%). The most common sources of infection were the respiratory tract (54.6%) and the gastrointestinal tract (30.4%). At baseline, the mean APACHE II score was 25.3 ± 3.4, and the mean SOFA score was 11.15 ± 2.0. The average number of organ failures per patient was 2.4 ± 0.4. Two-organ failure was observed in 58.7% of patients, while 41.3% had failure of three organs. Following continuous renal replacement therapy (CRRT): The number of failing organs in survivors decreased from 2.2 ± 0.41 to 0.8 ± 0.74 (p < 0.05). In non-survivors, it decreased from 2.58 ± 0.5 to 2.31 ± 0.67. Similarly, SOFA scores in survivors reduced from 11.1 ± 1.7 to 6.15 ± 2.1 (p < 0.05), while in non-survivors, scores decreased from 11.19 ± 1.5 to 10.31 ± 2.2. Heart rate decreased from 119 ± 27 to 90 ± 16 bpm in survivors, but increased from 100 ± 21 to 115 ± 18 bpm in non-survivors. Urine output improved in both groups, rising from 190 ± 198 mL to 990 ± 382 mL in survivors and from 192.3 ± 224 mL to 807 ± 314 mL in non-survivors. Blood pH improved from 6.15 ± 2.1 to 7.22 ± 0.17 in survivors and slightly increased from 7.12 ± 0.1 to 7.2 ± 0.1 in non-survivors. Lactate levels decreased in both groups, from 4.8 ± 1.8 to 2.1 ± 0.8 mmol/L in survivors and from 6.0 ± 2.7 to 3.9 ± 2.1 mmol/L in non-survivors. The average time to shock resolution was 38.95 ± 57.7 hours, with a shock reversal rate of 48.8%. The overall mortality rate was 52.2%. Patients who started CRRT within 24 hours had a survival rate of 57.1%, while those who started after 24 hours had a 100% mortality rate. Regarding treatment sessions, 39.1% of patients underwent a single CRRT session, and another 39.1% received two sessions. Conclusion: Continuous renal replacement therapy (CRRT) plays a vital role and demonstrates high efficacy in the comprehensive treatment of multiple organ failure caused by septic shock.