中国血液净化

›› 2004, Vol. 3 ›› Issue (4): 188-191.

• 论著 • 上一篇    下一篇

不同血液净化方式治疗心脏手术后急性肾衰竭的疗效比较研究

何朝生 史 伟 梁馨苓 叶智明 刘双信 梁永正 李如恒 杨满青   

  1. 510080 广州， 广东省人民医院肾内科(何朝生，史伟，梁馨苓，叶智明，刘双信，梁永正，李如恒)心血管病研究所(杨满青)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-04-12 发布日期:2004-04-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-04-12 Published:2004-04-12

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摘要：

目的 探讨连续性血液净化（ CBP）、间歇性血液透析（IHD）、腹膜透析（PD）治疗心脏手术后急性 肾功能衰竭（ARF）的疗效及预后差别。方法 回顾性分析1990年12月～2003年12月我院心脏手术后发生ARF需要血液净化治疗的患者148例，其中43例给予CBP治疗，77例接受IHD治疗，28例接受PD治疗，对比分析各组患者的临床资料、疗效和预后。结果 CBP组26例(60.5%)死亡,17例(39.5%)存活, IHD组50例(64.9%)死亡,27例(35.1%)存活,PD组17例（60.7％）死亡，11例（39.3％）存活，各组无差异,但CBP组病情明显重于IHD组和PD组：患者年龄更大,平均动脉压低,APACHEⅡ积分高,衰竭器官数目多,需要机械通气和升压药物的患者数高于IHD组 (P<0.01)及 PD组（ P<0.05）, CBP组中存活者平均APACHEⅡ积分与IHD组及PD组死亡者相似。结论 CBP治疗心脏手术后ARF的疗效优于IHD及PD,能明显改善ARF的预后。

关键词: 血液净化, 急性肾功能衰竭, 心脏手术

Abstract:

Objective To investigate the efficacy and prognosis of various blood purification (CVVH、IHD、PD)in acute renal failure patients following cardiac surgery. Methods One hundred and forty-eight patients with acute renal failure (ARF) after cardiac surgery who received renal surpport therapy between Dec 1990 and Dec 2003 were involved in this study. Of them, 43 were treated with continuous veno-venous hemofiltration(CVVH)(CBP group), 77 with intermiffent hemodialysis (IHD group) and 28 were treated with peritoneal dialysis (PD group). Results Seventeen (39.5%) patients in CBP group survived and 26(60.5%) patients died, while 27 (35.1%) patients in IHD group survived and 50 (64.9%) patients died, 11 (39.3%) patients in PD group survived and 17 (60.7%) patients died, no significant difference in survival rate was found among three groups (P=0.45). Patients in CBP group were more severe as manifested by a lower mean arterial pressure, higher APACHEⅡ score,more dysfunctioned organs and more frequent requirement of mechanical ventilation and vasopressor support as compared with patients in other groups(P<0.05). The average APACHEⅡ score of survival in CBP group is similar to the died in other groups. Conclusion Our data suggest that CBP therapy is an effective treatment for acute renal failure after cardiac surgery and can improve the prognosis.

Key words: Acute renal failure, Cardiac surgery

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