中国血液净化

中国血液净化 ›› 2012, Vol. 11 ›› Issue (11): 611-615.

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自动腹膜透析与CVVH治疗多器官功能障碍综合征并急性肾损伤的临床研究

陈林1,李剑文1,刘日光1,梁鸣2,陈浩雄1,秦曙光2,傅君舟1   

  1. 1. 广州市第一人民医院
    2.
  • 收稿日期:2012-05-07 修回日期:2012-08-26 出版日期:2012-11-12 发布日期:2012-11-12
  • 通讯作者: 傅君舟 E-mail:fujzh@tom.com
  • 基金资助:

    中科级.863

Comparing continuous venovenous hemofiltration and automated peritoneal dialysis in MODS patients with acute kidney injury

  • Received:2012-05-07 Revised:2012-08-26 Online:2012-11-12 Published:2012-11-12

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摘要： 【摘要】目的 比较应用床边自动腹膜透析（Automated Peritoneal Dialysis, APD）及连续静-静脉血液滤过(Continuous Venovenous Hemofiltration ,CVVH)技术在多器官功能障碍综合征（Multiple Organ Dysfunction Syndrome，MODS）合并急性肾损伤（Acute Kidney Injury，AKI）患者救治的临床疗效，探讨APD抢救MODS患者并AKI的临床应用前景。方法 回顾性分析我院2010 年1月～2011年3月期间使用APD与CVVH治疗AKI并MODS患者的临床资料。结果 2010 年1月～2011年3月，我院使用肾替代治疗AKI并MODS 患者共33例，其中APD组治疗14例，CVVH组治疗19例。所有患者至少合并2个器官功能障碍，符合MODS的诊断及AKI RIFLE 标准 F期，全部患者均需呼吸机辅助通气。两组患者间的年龄、性别、APACHEII 评分、透前血清Scr、BUN、ECO2、K+等无统计学差异（P>0.05）。两组患者经治疗后，血清Scr、BUN逐渐下降，电解质、酸碱平衡紊乱均得以纠正，单次治疗平均超滤量APD组与CVVH组无统计学差异（2496±1018 vs 3134±1267ml, P =0.15）；两组(APD vs CVVH)患者30天死亡率、肾功能恢复率无统计学差异（75.0% vs 78.9%,P=0.68;0% vs 5.9%,P=1.00）。两组患者治疗期间均未发生导管相关感染；CVVH组患者出血并发症发生率高于APD组（15.8%vs0%，P=0.27）；APD组单次治疗费用明显低于CVVH（612 vs 4230元）。结论 APD能有效清除MODS并AKI患者血清BUN、Cr，纠正电解质及酸碱平衡紊乱，是MODS并AKI患者有效的肾替代治疗方式之一。

关键词: 自动腹膜透析, 连续静-静脉血液滤过, 急性肾损伤, 多器官功能障碍综合征

Abstract: [Abstract] Objective To investigate the role of APD in MODS with AKI patients requiring continuous renal replacement therapies. Methods Retrospectively reviewed MODS with AKI cases treated with APD(Group A) or CVVH(Group B) from 2010 January to 2011 March. The clinical characteristics，causative of AKI，treatment modalities，and outcomes were analyzed and compared with these two groups.Results Group A and group B comprised 14 cases and 19 cases respectively. There were no significant differences between two groups in baseline clinical characteristics. Furthermore, The groups were similar in metabolic control and correction of fluid overload. BUN,serum creatinine, and bicarbonate levels were stabilized after 72h treatment procedure. Mortality was 75% in group A and 78.9% in group B(P=0.68). There was no significant difference in infectious complications rate between two groups. Cost of disposables was higher in group B than in group A.Conclusions APD may be a safe, effective and low cost alternative to renal replacement therapy in MODS with AKI.

Key words: APD, CVVH, Acute Kidney Injury, MODS