中国血液净化

›› 2006, Vol. 5 ›› Issue (11): 762-765.

• 论著 • 上一篇    下一篇

连续性血液净化在心脏术后严重肾衰竭中的应用　　　　　　　　　　　　　　

刘 玲　姜春生　陈文梅　史俊霞   

  1. 100029　北京，北京安贞医院血液净化中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-11-12 发布日期:2006-11-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-11-12 Published:2006-11-12

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摘要： 目的　探讨连续性血液净化(CBP)治疗心脏术后急性肾衰竭的时机及有效性。方法　对北京安贞医院血液净化中心2003年11月～2005年8月70例心脏手术后因急性肾衰竭接受连续性血液净化的患者分为生存组和死亡组，将其临床资料进行回顾分析比较。CBP方式以连续性静脉－静脉血液透析滤过(CVVHDF)及连续性静脉－静脉血液滤过(CVVH)为主，对两组患者治疗前进行APACHEⅡ评分，并分别观察两组患者治疗前、治疗24h、48h和72h平均动脉压(MAP)、心率(HR)、氧合指数(PaO2/FiO2)、血乳酸(Lac)等指标，观察治疗前及治疗期间的白细胞(WBC)及血小板(Plt）计数、肾功能(BUN、Cr)、心肌酶(AST、CPK、LDH)的变化。结果　70例患者中存活35例，死亡35例。两组患者治疗前APACHEII评分、MAP、Lac、BUN、Cr及CPK、AST差异存在显著性(P＜0.05)。经CBP后两组患者MAP、PaO2/FiO2、BUN、Cr和心肌酶较治疗前均有明显改善(P＜0.05)，而HR、WBC和Plt治疗前后变化不明显(P＞0.05)。结论　CBP是治疗心脏术后并发严重急性肾衰竭的有效手段，尽早进行CBP有助于减少多脏器功能衰竭的发生，降低死亡率。

关键词: 连续性血液净化, 心脏术后, 急性肾衰竭

Abstract:

Objective Acute renal failure(ARF) following cardiac surgery remains a significant cause of mortality. The aim of this study is to evaluate the effect and the timing of continuous blood purification(CBP) for acute renal failure following cardiac surgery. Methods From January ,2004 to August 2005, 70 patients with acute renal failure following cardiac operation were divided into two groups: Alive group and dead group. The treatment model were continuous venovenous hemodialfiltration(CVVHDF)and continuous venovenous hemofiltration(CVVH). Clinical data of the two groups were reviewd. Before treatment,APACHRII scores were evaluated. Mean arterial pressure(MAP), heart rate(HR), oxygenic index (PaO2/FiO2),blood lactate(Lac), white blood cell count(WBC), platelet count(Plt),blood urea nitrogen(BUN), creatinine (Cr) and myocardial enzymes (aspartate aminotransferase AST, creatine phosphokinase CPK, lactate dehydrogenase LDH) were observed before CBP and after 24-hour, 48-hour and 72-hour post CBP. Results Thirty-five patients were alive and 35 dead during the course of treatment. APACHRII scores of dead group was significantly higher than the alive group (P ＜0.05) before CBP. Compared with alive group there were distinct differences(P ＜0.05) in MAP, Lac, BUN, Cr, CPK and AST of dead group before CBP. After CBP there were’s siginificant improvement in MAP,PaO2/FiO2,BUN,Cr, AST,CPK and LDH (P ＜0.05), while there was no difference in HR、WBC and Plt of the two groups. Conclusion CBP is an effective treatment for acute renal failure following cardiac surgery. The sooner the ARF after cardiac surgery is recognized and CBP is performed, the greater the chances of reducing the multiple organ dysfunction syndrome and mortality.

Key words: Acute renal failure, Cardiac operation

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