论文部分内容阅读
目的 观察血液透析与连续性肾脏替代治疗 (CRRT)在心脏术后急性肾功能衰竭患者中的应用效果。方法 分别用常规血透、简易床边血透和连续性静脉静脉血液滤过 (CVVH)或透析滤过 (CVVHDF)治疗 2 5例心脏术后急性肾功能衰竭患者。结果 2例常规血透患者因循环稳定、无并发症全部康复。 2 3例行床边治疗 ,其中简易血透的 15例 ,死亡 8例 ,占5 3 3% ;8例日间CVVH或CVVHDF患者死亡 3例 ,占 37 5 % ,但两组死亡率差别不显著。简易透析和滤过均能有效清除体内多余水分 ,纠正高钾血症 ,血尿素氮、肌酐较透析前有不同程度下降。死亡组患者衰竭脏器数明显多于存活组 (2 80± 0 92vs1 5 7± 0 6 4,P <0 0 1) ,首次透析治疗前血肌酐浓度高于存活组 (412 6± 2 0 0 6 μmol/Lvs2 92 9± 138 5 μmol/L ,P <0 0 5 )。 结论 影响心脏术后急性肾功能衰竭患者死亡率的一个重要因素是受累脏器的个数 ,早期血液净化治疗可能改善患者预后 ;虽然差别不显著 ,但CRRT治疗组死亡率有下降趋势。
Objective To observe the effect of hemodialysis and continuous renal replacement therapy (CRRT) in patients with acute renal failure after cardiac surgery. Methods Twenty-five patients with acute renal failure after cardiac surgery were treated with conventional hemodialysis, simple bedside hemodialysis and continuous venous venous hemofiltration (CVVH) or dialysis filtration (CVVHDF) respectively. Results 2 cases of conventional hemodialysis patients due to stable circulation, no complications all recovered. There were 15 cases of simple hemodialysis and 8 cases of death, accounting for 53.3%. Three patients died of CVVH or CVVHDF during the day, accounting for 37.5%, but the difference between the two groups was not significant Significant. Simple dialysis and filtration can effectively remove excess body water, correct hyperkalemia, blood urea nitrogen, creatinine than before dialysis decreased in varying degrees. The number of organ failure in the death group was significantly higher than that in the survival group (280 ± 92 vs 157 ± 064, P <0.01). The serum creatinine concentration in the death group was higher than that in the survival group (412 6 ± 200 6 μmol / L vs 92 9 ± 138 5 μmol / L, P <0 05). Conclusions An important factor influencing the mortality of patients with acute renal failure after cardiac surgery is the number of organs involved. Early blood purification may improve the prognosis of patients. Although the difference is not significant, the mortality of CRRT patients decreases.