中国血液净化

›› 2007, Vol. 6 ›› Issue (2): 78-80.

• 论著 • 上一篇    下一篇

连续性静-静脉血液滤过对全身炎性反应综合征合并急性肾衰竭患者血流动力学的影响

于 光1 袁伟杰1 邓小明2 朱科明2 李金宝2 苗玉良2 付 鹏1 苏 红1 吴 灏1   

  1. 200433 上海，第二军医大学附属长海医院1肾内科，2麻醉科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-02-12 发布日期:2007-02-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-02-12 Published:2007-02-12

RichHTML

0

PDF

667

摘要：

目的 研究连续性静-静脉血液滤过(CVVH)对全身炎性反应综合征(SIRS)合并急性肾衰竭(ARF)重症患者血流动力学的影响。方法 选择第二军医大学附属长海医院肾内科16例SIRS合并ARF重症患者在明确诊断后行CVVH，平均治疗时间5日。采用股静脉留置单针双腔导管，建立血管通路、体外循环。使用 Diapact CRRT机(Braun, 德国)，F60管道和血液滤过器(聚砜膜，1.2m2)。经桡动脉置管监测有创动脉压(MAP)，经右侧颈内静脉置入Swan-Ganz导管。于CVVH治疗前和治疗后2h、4h、6h、结束后6h动态监测心率(HR)、肺毛细血管楔压(PAWP)、中心静脉压(CVP)、心排量(CO)，并推算出心脏指数(CI)、体循环阻力(SVR)与肺血管阻力(PVR)。同时抽取静脉血检测电解质和肾功能。结果 16例患者血流动力学指标除HR在CVVH后有显著下降，而MAP、PAWP、CVP、CO、CI、SVR及PVR各项指标无显著改变。治疗后BUN、Cr、K+有显著下降。16例患者存活11例，最后死亡5例。结论 CVVH治疗能稳定患者的血流动力学变化，溶质清除较好，并发症少，可用于SIRS合并ARF的治疗。

关键词: 连续性静-静脉血液滤过, 血流动力学, 全身炎性反应综合征, 急性肾衰竭

Abstract:

Objective To investigate the effects of continuous venovenous hemofiltration (CVVH) on the change of hemodynamics in patients with systemic inflammatory response syndrome (SIRS) and acute renal failure (ARF). Methods Sixteen patients with SIRS and ARF in intensive care unit of our hospital were scheduled for the treatment of CVVH. All patients were satisfied the criteria of SIRS and ARF. Except for routine monitors, mean invasive arterial pressure was monitored,and arterial blood gas analyzed by the catheter of radial artery. The change of hemodynamics was monitored by Swan-Ganz catheter, which was put in through the right jugular vein. A double trunk catheter was put into the right femoral vein and the CVVH was done with the Diapact CRRT (Braun, Germen). PS hemofilter(1.2m2) was applied. The HR, MAP, PAWP, CVP, CO, CI, SVR and PVR, blood biochemical markers including electrolytes, urea nitrogen and creatinine, arterial blood gas were recorded or measured at 0h, 2h, 4h, 6h following CVVH and 6h post-CVVH. Results No significant difference was found in the parameters of hemodynamics except for HR significant decrease following CVVH. BUN, Scr and serum K+ levels decreased significantly following CVVH. Conclusion CVVH could impove the blood biochemical markers including BUN、Scr and serum K+ with little harmful effect on hemodynamics in patients with SIRS/ARF.

Key words: Hemodynamics, Systemic inflammatory response syndrome(SIRS), Acute renal failure(ARF)

中图分类号: