CAVH用于肾移植后体内水钠潴留的疗效观察

为观察连续性动静脉血液滤过(CAVH)用于肾移植后体内水钠潴留患者的疗效,对我院89例肾移植后体内水钠潴留患者行CAVH,使用床边P-21泵血滤机及膜面1.4 m~2聚砜膜透析器,使用低分子肝素抗凝,流速25～45mL/min。在血滤过程中,使用10％NaCl 10 mL,输白蛋白、全血、林格平衡液;监测心率、血压、液体出入量、细胞因子、移植肾功能、血气、胸片、电解质及酸碱平衡情况。追踪1～2年,78例(随防1年)、75例(随防2年)移植肾功能恢复良好,67例患者心功能及肺部通气功能改善,4例规律透析,11例死于多脏器衰竭。提示:应用CAVH可减少血容量,减轻细胞内外水肿,从而减轻移植肾、肺、脑水肿,从而改善移植肾的功能及肺泡通气功能;CAVH用于急诊重症患者是安全、有效和简便的。

Dehydration Therapy in Edema of Renal Transplantation

To observe the aim of this study was to explore the practical approach for treating patients with CAVH. Eighty-nine kidney transplant recipients were studied. All patients were treated with CAVH (dialysate flow rate is 2 L/h). Whole or washed blood cells or plasm were re-circulated at 25-45 mL/min through a 1.4 m2 polysulfones hemofilters for 4~8 h with filtration. In every 30 min 10 mL of 10% NaCl was infused into the circulation. Immunosuppressive agents were used continuously during that period. Blood and albumin were also used. Each measurement was performed immediately before and every 30 min after commencement of technique of filtration. The main measurement included heart rate, blood pressure, output of filtrated water, cytokine, allograf t function, blood-gas and chest X-ray. Results: 67 cases with renal and heart function recovered well and 78 cases with renal allograf t recovered well after 1 to 2 years. Four patients were on regular dialysis. Eleven patients died of multi-organ failure (MOF). The use of CAVH would reduce vascular volume, extra-cellular or intracellular fluid volume. It could reduce renal allograf t edema without affecting blood pressure and electrolyte, and improve allograft function and pulmonary alveolus ventilation. CAVH is safe, effective, simple and convenient.