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目的:比较连续性静脉-静脉血液滤过(连续性血滤,CVVH)与间歇性血液滤过(间歇性血滤,I HF)治疗重症急性肾衰竭(sARF)的疗效和血流动力学影响。方法:回顾分析了2005年1月～2006年12月期间353例肾脏替代治疗的急性肾衰竭患者。其中,42例急性肾小管坏死引起的sARF患者进入研究。16例行CVVH(CVVH组),26例行I HF(I HF组)。结果:CVVH组与I HF组的APACHEⅡ平均值、病死率和最低平均动脉压(MBPmin)均无统计学差异(P>0.05),分别为30.3±9.3 vs 26.6±8.6、81.3%vs 61.5%和(66.2±13.4)mmHg vs(69.6±15.6)mmHg。死亡患者的APACHEⅡ平均值明显高于存活者,分别为31.2±7.1 vs 20.9±8.6,P<0.01。APACHEⅡ分值与MBPmin的呈负相关,P<0.001。结论:与I HF相比,CVVH未能明显改善sARF患者的血流动力学稳定性,未能明显降低病死率。病情的危重程度是sARF患者预后和血流动力学稳定性的主要影响因素。
PURPOSE: To compare the efficacy and hemodynamic effects of continuous veno-venous hemofiltration (CVVH) and intermittent hemofiltration (intermittent hemofiltration, I HF) in the treatment of severe acute renal failure (sARF) . Methods: A retrospective analysis of January 2005 ~ December 2006 353 cases of renal replacement therapy in patients with acute renal failure. Among them, 42 cases of acute tubular necrosis caused by sARF patients into the study. Sixteen patients underwent CVVH (CVVH group) and 26 patients underwent I HF (I HF group). Results: There were no significant differences in APACHEⅡ, CFR and MBPmin between CVVH group and I HF group (P> 0.05), which were 30.3 ± 9.3 vs 26.6 ± 8.6, 81.3% vs 61.5% and (66.2 ± 13.4) mmHg vs (69.6 ± 15.6) mmHg. The average APACHE II of death patients was significantly higher than those of survivors, which were 31.2 ± 7.1 vs 20.9 ± 8.6, P <0.01. APACHE II score was negatively correlated with MBPmin, P <0.001. CONCLUSIONS: CVVH did not significantly improve hemodynamic stability in patients with sARF compared to I HF, and did not significantly reduce mortality. The severity of the disease is the main prognostic factor for sARF and hemodynamic stability of the main factors.