中国血液净化

›› 2007, Vol. 6 ›› Issue (5): 246-248.

• 论著 • 上一篇    下一篇

高容量血液滤过治疗急性肾衰竭合并多器官功能障碍综合征的体会

李 越 安桂侠 王金荣 杜丽洁 才 慧 王冬梅   

  1. 110016 沈阳，辽宁省人民医院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-05-12 发布日期:2007-05-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-05-12 Published:2007-05-12

RichHTML

0

PDF

249

摘要： 目的 观察高容量血液滤过(High volume hemofiltration HVHF)治疗急性肾衰竭(Acute renal failure ARF)合并多器官功能障碍综合征(multiple organ dysfunction syndrome MODS)的疗效。方法 选择辽宁省人民医院血液净化中心24例ARF合并MODS患者随机分为APACHEⅡ(acutephysiology and chronicⅡ)评分差异无显著性的2组，A组13例行HVHF治疗，B组11例行连续性静脉-静脉血液滤过(Continuous venuou-venuous hemofiltration CVVH)治疗。比较二组治疗前后血BUN、Scr、K+、Na+、 Ca++、CO2CP、IL-6、TNF-α水平的变化，及治疗过程中平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)的变化。结果 A组存活8例，死亡5例，病死率38.5%；B组存活6例，死亡5例，病死率45.5%，二组差异无显著性(P＞0.05)。HVHF治疗过程中血流动力学稳定，治疗结束后血BUN、Scr、水电解质、酸碱失衡均得到较好控制，二组差异无显著性(P＞0.05)，但治疗后血IL-6、TNF-α水平的下降A组明显优于B组，且差异具有显著性(P＜0.05)。结论 HVHF和CVVH均能有效地清除溶质和水份，调整离子和酸碱平衡，且有十分稳定的血流动力学，而清除中大分子炎症介质的效力则HVHF明显优于CVVH，HVHF较CVVH更适合于ARF合并MODS的治疗。

关键词: 高容量血液滤过, 急性肾衰竭, 多器官功能障碍综合征

Abstract:

Objective To observe the therapeutic effects of high volume hemofiltration (HVHF) in the treatment of acute renal failure complicated with multiple organ dysfunction syndrome. Methods Patients with acute renal failure complicated with multiple organ dysfunction syndrome were randomly divided into 2 groups of which the APACHE II (acute physiology and chronic II) scores had no statistical difference. Thirteen cases in group A were treated with HVHF, and eleven cases in group B with continuous venous-venous hemofiltration. Changes of BUN and serum Cr, K+, Na+, Ca2+, CO2, IL-6 and TNF- were compared between the 2 groups before and after the treatment. Mean arterial pressure, central venous pressure and heart rate were monitored during the treatment. Results In group A, 8 cases survived and the mortality rate was 38.5%. In group B, 6 cases survived and the mortality was 45.5% (P>0.05, as compared with the mortality rate of group A). Patients in group A showed stable blood flow dynamics and favorable changes of BUN, Cr, electrolytes and acid-base balance (P>0.05, as compared with those of group B). However, serum IL-6 and TNF- decreased more in group A than in group B after the treatment (P<0.05). Conclusion Although both HVHF and continuous venous-venous hemofiltration effectively excreted extra solutes and water and appropriately adjusted ionic and acid-base balance with little disturbance on blood flow dynamics, HVHF has better ability in the elimination of inflammatory factors of medium and large sizes.

Key words: Acute renal failure, Multiple organ dysfunction syndrome

中图分类号: