中国血液净化

›› 2005, Vol. 4 ›› Issue (4): 201-204.

• 论著 • 上一篇    下一篇

连续性肾脏替代治疗在心脏术后MODS合并ARF中的应用

刘宏宝 王汉民 李振江 陈 威 张 鹏 徐月清   

  1. 710032 西安，第四军医大学西京医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-04-12 发布日期:2005-04-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2005-04-12 Published:2005-04-12

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摘要：

目的 探讨连续性肾脏替代治疗(CRRT)在心脏术后多脏器功能障碍综合征（MODS）合并急性 肾衰竭（ARF）中的疗效和预后。方法 将47例行CRRT治疗的心脏术后MODS合并ARF患者分为存活组（A组，26例）和死亡组（B组，21例），分别进行MODS评分、APACHE Ⅲ评分、术前心功能分级、体外循环时间、CRRT距ARF和尿量＜0.5ml·Kg-1·h-1时间、平均动脉压（MAP）、氧合指数、血尿素氮（BUN）和血肌酐（Scr）等指标的比较。结果 ① 治疗前B组受损的器官数明显多于A组（P<0.05）；② CRRT前B组MODS评分和APACHE Ⅲ评分显著高于A组（ P<0.05），CRRT治疗12h后，仅A组MODS评分和APACHE Ⅲ评分明显下降（ P<0.05）； ③ CRRT治疗12h后，两组血尿素氮和血肌酐均明显降低，仅A组氧合指数增高（ P<0.05）；④ B组的CRRT距ARF和尿量＜0.5ml·Kg-1·h-1时间明显高于A组（ P<0.05）。结论 心脏术后 MODS器官损害数多的患者病死率高。将MODS评分与APACHE Ⅲ评分系统结合应用，能较精确地评定心脏术后MODS合并ARF患者病情的严重程度。CRRT是该类患者治疗的有效手段，但必须强调早期ARF诊断和及时CRRT治疗，行CRRT治疗越晚其预后越差，尽早行CRRT治疗，对改善患者的预后有积极作用。

关键词: 连续性肾脏替代治疗, 急性肾衰竭, 多脏器功能障碍综合征, 心脏手术

Abstract:

Objective To evaluate the efficiency and prognosis of continuous renal replacement therapy(CRRT) in patients with multiple organ dysfunction syndrome(MODS) and acute renal failure(ARF) after cardiac surgery. Methods Fourty-seven patients with MODS and acute renal failure(ARF) after cardiac surgery were treated with CRRT. They were divided into two groups according to prognosis:26 survival as group A and 21 death as group B.MODS scores,APACHE Ⅲ scores,heartfunction grade before surgery, duration of extracorporeal circulation,duration from ARF and urine volume ＜0.5ml·Kg-1·h-1 to CRRT, mean arterial pressure（MAP）, oxygenic index,blood urea nitrogen（BUN） and serum creatinine（Scr）were analyzed and compared. Results ① Before CRRT the numbers of impaired organs of patients in group B were significantly more than that in group A（P<0.05）; ② MODS scores （12.5±2.8 vs 7.6 ± 2.7，P<0.05） and APACHE Ⅲ scores （85.1±16.8 vs 71.1±16.7，P<0.05）of group B were significantly higher than that of group A before CRRT. After a 12-hour,s treatment of CRRT, APACHE Ⅲ scores and MODS scores in group A were significantly decreased (P<0.05); ③ After a 12-hour,s treatment of CRRT,BUN and Scr were significantly decreased in all patients,but oxygenic index was significantly increased only in group A (P<0.05); ④ The duration of ARF before CRRT（32.3±39.3 hours vs 12.7±10.7 hours, P<0.05） and the time of urine volume ＜ 0.5ml·Kg-1·h-1 before CRRT（37.7±39.2 hours vs 15.7±14.8 hours, P<0.05）were significantly higher than that of group A. Conclusion There is higher mortality rate in patients with more impaired organs after cardiac operation.MODS scores and APACHE Ⅲ scores can be used to evaluate the severity and prognosis of patients with MODS and ARF after cardiac surgery. CRRT is an important treatment to these patients.But the most important problem in this process is the recognition of ARF and early beginning of the therapy. The prognosis of these patients correlated with early CRRT therapy.It is suggested that early CRRT therapy is beneficial for prognosis and reducing mortality rate of these patients.

Key words: Acute renal failure, Multiple organ dysfunction syndrome, Cardiac surgery

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