连续性静脉静脉血液透析滤过在重型颅脑外伤合并急性肾功能衰竭中的应用研究

目的观察在重型颅脑外伤合并患性肾功能衰竭患者中应用连续性静脉静脉血液透析滤过的治疗方法的效果和有待解决的问题。方法回顾性分析重型颅脑外伤患者41例，按照治疗过程中是否发生急性肾功能衰竭划分为A组（急性肾衰组）23例，B组（对照组）18例，二组患者在性剐、年龄等方面差异无统计学意义。A组患者出现肾衰后停用甘露醇，进行奎天连续性静脉静脉血液透析浇过，B组常规治疗。记录二组患者屈内压、肝肾功、电解质酸碱度变化，1周后APACHEⅢ评分和2周内死亡例数和A组患者肾裹出现时间，连续性静脉静脉血液透析逮过患者滤器使用时间、治疗时间、治疗前后凝血时间改变等数值。结果A组出现肾衰时间为入院后（2．8±1．2）d，行连续性静脉静脉血液透析逢过时间（68±17）h，每个滤器使用时同（23±11）h，患者治疗前后体内凝血时间比较差异无统计擎意义。二组患者的肝功能、酸碱度比较差异无统计学意义（P〉0．05），肾衰组肾功能指标明显高于B组（P〈0．01），血钾、血钠平均值有明显差异．A组反而曼接近正常范围。A组患者颅内压平均值明显比B组高，颅内压波动范围却比B组小（P〈0．05），A组患者1周后APACHEⅢ评分和2周内死亡例数明显大于B组（P〈0．01）。结论在重型颅脑外伤合并患性肾功能衰竭患者中应用连续性静脉静脉血液透析滤过的治疗方法有明显的稳定电解质等内环境指标的作用，但是这些患者颅内压数值和病死率仍然明显增高，治疗中仍然存在很多待解决的问题。

APPLICATION OF CONTINONS VENOVENOAS HEMODIAFILTRATION IN SEVERE CRANIOCEREBRAL INJURIED PATIENTS WITH ACUTE RENAL FAILURE

Objective To investigate the clinical value of continous venovenous hemodiafiltration in severe craniocerebral iniuried patients with acute renal failure. Methods 41 patients with severe craniocerebral injury were studied, who were divided randomly into two groups accordingly to acute renal failure occurrence or not during treatment course. Group A （acute renal failure group） had 23 paitents, group B（ compared group） 18 paitents. The clinical data of the two groups were similar when hospitalized. Group A stopped mannitol and started whole- day continous venovenous hemodiafiltration, group B undergoing regular therapy. The values listed below were recorded, intracranial pressure,liver ruction, renal ruction, power of hydrogen, electrolyte change every day and APACHE m grade after a week and death rate in two weeks, occurrence time of acute renal failure, treatment time, blood filter time, and cruor index changes during continous venovenous hemodiafiltration. Results Group A（acute renal failure group） occurred acute renal failure in 2.8 ± 1.2 days,range 1-6 days） undergoed continous venovenous hemodiafiltration 68± 17 hours, range 19 - 307 hours） every blood filter were used 23± 11 hours, range 6 - 77 hours. The cruor index changes were not significant during continous venovenous hemodiafiltration. Liver ruction, power of hydrogen of group A were similar than those of group B （P〉0. 05） ,renal ruction of group A was worse than that of group B （P〈0.01）,blood potassium and sodium of group A were more normal than those of group B（P〈0.05）. Intracranial pressure of group A were higher than that of group B ,but the fluctuation range was smaller than that of group B （P〈0.05）. APACHE m grade after a week and death rate in two weeks of group A were worse than those of group B（P〈0.01）. Conclusion The application of con- tinous venovenous hemodiafiltration in severe craniocerebral injuried patients with acute renal failure is a good method to stabilize indexes of electrolyte and