【摘要】目的 观察连续性血液净化治疗在妊娠合并急性肾衰竭的应用。方法 18例妊娠合并急性肾衰竭的患者行连续性血液净化治疗，用前稀释连续静-静脉血液透析滤过(CVVHDF)治疗，观察治疗前后血尿素氮、血肌酐、电解质、血pH值、血常规、CRP、APACHEⅡ评分，用放射免疫法测定治疗前、12h、24h、治疗后血液及废液中白介素-6、肿瘤坏死因子-α水平。 结果 18例病人中，16例痊愈，1例死亡，1例转为慢性肾衰竭。治疗后血BUN、Cr较治疗前明显下降(P＜0.05）；血电解质、血白细胞数及血pH值正常；CRP、APACHEⅡ评分、白介素-6、肿瘤坏死因子-α水平较治疗前下降，有显著差异(P＜0.05）。 结论 妊娠合并急性肾衰竭早期行连续性血液净化治疗疗效好，其机制明显降低白介素-6、肿瘤坏死因子-α水平，降低炎症反应，使抗炎因子和促炎因子趋于动态平衡。
【Abstract】 Objective To evaluate continuous blood purification in the treatment of pregnancy with acute renal failure. Methods Eighteen pregnant women with acute renal failure were treated with continuous venovenus hemodiafiltration. APACHE II score and plasma BUN, Cr, K+, Na+, Cl-, Ca2+, CRP and pH were measured before and after the treatment. IL-6 and TNF-α concentrations in serum and in outflow fluid were measured by radioimmunoassay before the treatment and after the treatment for 12 and 24h. Results Among the 18 patients, 16 cases recovered, one case died, and one case progressed to become chronic renal failure. After the treatment, plasma BUN and Cr decreased (P<0.05), WBC, plasma electrolytes and pH returned to be normal, and APACHE II score, and plasma CRP, IL-6 and TNF-α were lower than those before the treatment (P<0.05). Conclusion Early continuous venovenus hemodiafiltration can improve the clinical conditions of pregnant women with acute renal failure. The therapeutic benefit may relate to the clearance of over-expressed IL-6 and TNF-α, resulting in the decrease of inflammatory activity and the balance between inflammatory and anti-inflammatory factors.
