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我们回顾性研究1974年至1992年收治的12例产科急性肾功能衰竭(ARF)患者。采用间歇性腹透(IPD)治疗2例,血透(HD)治疗8例,连续动静脉血滤(CAVH)及血液滤过(HF)各一例。12例中8例治愈,4例死亡(33.3%),多系统器官衰竭(MSOF)为主要死因。IPD可以作为产科ARF的治疗措施,适用于基层单位及有HD禁忌症者。HD清除氮质代谢产物的效率优于IPD,因此在危重或高分解代谢状态者仍以此法为宜。对心血管功能不稳定、心衰并发低血压、呼吸窘迫综合征(ARDS)及MSOF者应选择CAVH。作者认为:血液净化是治疗产科ARF的重要措施之一,但必须掌握整体综合治疗,除积极治疗原发病外,应加强对重要脏器功能进行动态监测,以防止MSOF的发生,对降低病死率有重要意义。
We retrospectively reviewed 12 patients with obstetric acute renal failure (ARF) who were admitted between 1974 and 1992. Two cases were treated with intermittent peritoneal dialysis (IPD), eight cases with hemodialysis (HD) and one case with continuous arteriovenous hemofiltration (CAVH) and hemodiafiltration (HF). Of the 12 patients, 8 were cured, 4 were fatal (33.3%) and MSOF was the major cause of death. IPD can be used as a treatment for obstetric ARF and is suitable for grassroots units and people with HD contraindications. HD removal of nitrogen metabolites is better than IPD, so in critically ill or highly catabolic state is still this method is appropriate. For cardiovascular instability, heart failure complicated by hypotension, respiratory distress syndrome (ARDS) and MSOF should choose CAVH. The author believes that blood purification is one of the important measures for the treatment of obstetric ARF, but we must master the overall comprehensive treatment, in addition to aggressive treatment of primary disease, should strengthen the vital organs of dynamic monitoring to prevent the occurrence of MSOF, reduce the incidence of death Rate is important.