Hemorrhagic cardiac tamponade in critically ill patients with acute renal failure

PURPOSE: The purpose of this study was to report the development, management, and follow up of tamponading uremic pericardial effusion in critically ill patients with acute renal failure. SETTING: The setting for this study was an adult, 24-bed tertiary multidisciplinary intensive care unit (ICU) of a university hospital. PATIENTS: The subjects were 5 critically ill patients with multiple organ failure including acute renal failure (ARF) that was slow to resolve. RESULTS: Renal involvement was attributed to renal hypoperfusion, sepsis and myoglobinuria. Continuous veno-venous hemofiltration (CVVH) was instituted early during hospitalization in 4 cases and lasted for 35 to 48 days; renal replacement therapy was not used in 1 case. Tamponade developed late in the course of ARF, after CVVH was discontinued in the 4 cases and was effectively managed with percutaneous pericardiocentesis under echocardiography and continuous catheter drainage of the pericardial sac for 48 to 72 hours. Hemorrhagic fluid (Hb 2.2-5.9 g/dL) with lymphocyte predominance was detected. Transient constrictive-like pericarditis findings were present in all patients after the procedure. All patients were discharged from the hospital in a good condition with normal serum and creatinine levels; 1-year follow up showed a normal echocardiogram. CONCLUSION: Awareness for the possibility of hemorrhagic pericarditis and cardiac tamponade is needed in ICU patients with ARF slow to resolve. Transient constrictive-like pericarditis may present after pericardiocentesis.     

连续肾脏替代治疗在肝移植中的应用

目的探讨连续肾脏替代治疗(CRRT)在肝移植术后急性肾功能衰竭(ARF)合并多器官功能不全(MODS)治疗中的应用价值。方法分析连续静脉静脉血液滤过(CVVH)治疗7例肝移植术后ARF、成人呼吸窘迫综合征(ARDS)、急性心衰、全身炎症反应综合征(SIRS)等患者。3例合并ARDS患者同时进行呼吸机辅助呼吸治疗。结果4例治愈,另3例ARF合并MODS患者死亡。经CVVH治疗后,患者血清中的肌酐、尿素氮、血钾较治疗前降低(P<0.05),凝血酶原时间变化无意义。结论CVVH能有效控制氮质血症和高血钾等高分解状态,而不影响凝血功能。早期应用可以改善肝移植术后ARF、ARDS、充血性心力衰竭、SIRS等MODS患者的预后。     

Phosphate kinetics during different dialysis modalities

BACKGROUND: An abnormal serum phosphate concentration is common in acute renal failure patients, with a reported incidence of 65-80%. Phosphate removal and kinetics during intermittent hemodialysis (IHD) have been investigated, but there is no information on its kinetics during slow low-efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT). METHODS: Eight IHD, 8 SLED, and 10 continuous venovenous hemofiltration (CVVH) patients with a residual renal clearance of <4.0 ml/min were studied during a single treatment to evaluate phosphate removal and kinetics. CVVH was studied the first 24 h after initiation. Dialysis/replacement fluid contained no phosphate. Kt/V, clearance of urea (Ku), inorganic phosphate (Kp) and solute removal was determined by direct dialysate quantification (DDQ). RESULTS: Kp recorded with the three techniques were: IHD, 126.9 +/- 18.4 ml/min; SLED, 58.0 +/- 15.8 ml/min, and CVVH, 31.5 +/- 6.0 ml/min. However, in shorter dialysis treatment the total removal of phosphate was significantly lower than in longer dialysis (IHD, 29.9 +/- 7.7 mmol; SLED, 37.6 +/- 9.6 mmol; CVVH, 66.7 +/- 18.9 mmol, p = 0.001). The duration of treatment is the only factor determining phosphate removal (r = 0.7, p < 0.0001 by linear correlation model). Like IHD, phosphate kinetics during SLED could not be explained by the two-pool kinetic model, and the rebound of phosphate extended beyond 1 h after dialysis. Rebound, however, is less marked than in short dialysis. CONCLUSION: These results are reliable evidence about amount of phosphate removal and behavior of intradialytic phosphate kinetics in renal failure patients undergoing different dialysis modalities. These data will help clinicians plan phosphate supplementation and treatment intensity.     

Continuous arteriovenous hemodialysis and continuous venovenous hemofiltration in burn patients with acute renal failure

Acute renal failure (ARF) is a very common condition that may occur in patients with major burn injuries. The majority of burn patients with ARF have a high mortality rate, ranging from 73% to 100%. There are several ways to treat ARF in burn patients, including peritoneal dialysis (PD), intermittent hemodialysis, and continuous renal replacement therapy (CRRT). CRRT is generally used in patients in whom intermittent hemodialysis has failed to control hypovolemia, as well as in patients who cannot tolerate intermittent hemodialysis. Additionally, PD is not suitable for patients with burns within the abdominal area. For these reasons, most patients with unstable hemodynamic conditions receive CRRT. In this study (conducted in our burn unit between 1997 and 2004), six burn patients received CRRT: three received continuous arteriovenous hemodialysis (CAVHD) and the other three received continuous venovenous hemofiltration (CVVH). The patients were all males, with a mean age of 49.8 years (range, 27-80 years), and a mean burnt surface area of 65.1% (range, 30-95%). Four patients died due to multiple organ failure, and two patients recovered from severe ARF. CRRT has been proven safe and useful for burn patients with ARF. According to this study, we conclude that CVVH is an appropriate tool for treating ARF, with a lower incidence of vascular complications than CAVHD.     

Abbreviated dosing of N-acetylcysteine prevents contrast-induced nephropathy after elective and urgent coronary angiography and intervention

BACKGROUND AND HYPOTHESIS: Several studies have utilized low-dose regimens of N-acetylcysteine (NAC) for 48 hours to prevent contrast-induced nephropathy (CIN) after cardiac catheterization (cath) and percutaneous coronary intervention (PCI). A lengthy pretreatment period with NAC may not be feasible in urgent situations. The purpose of this study was to assess the efficacy of an abbreviated, higher dose regimen of NAC for the prevention of CIN after elective and urgent coronary angiography (cath) and/or percutaneous coronary intervention (PCI). METHODS: We prospectively evaluated 80 patients referred for elective or urgent cath and/or PCI with stable chronic renal insufficiency (creatinine clearance <50 cc/min). Patients were randomized to: NAC 1000 mg PO 1 hour before cath/PCI and 4 hours later, or placebo. All patients received hydration (0.9% saline) before and after cath/PCI (minimum total volume > or = 1500 mL). CIN was defined as an increase of Cr > or = 0.5 mg/dL or > or = 25% 48 hours after cath/PCI. RESULTS: CIN occurred in 3 of 36 (8%) patients of the NAC group vs. 11 of 44 (25%) in the placebo group (P = 0.051; OR 3.7, 95% CI 0.94-14.4). Serum creatinine (mean +/- SD) remained stable in the NAC group after cath/PCI (2.02 +/- 0.56 vs. 2.10 +/- 0.81 mg/dL; P = 0.34), but increased after cath/PCI in the placebo group (1.93 +/- 0.53 vs. 2.10 +/- 0.74 mg/dL; P < 0.01). CONCLUSIONS: An abbreviated, higher dose regimen of NAC prevents the rise of serum creatinine 48 hours after cath/PCI, and may prevent CIN after cath/PCI.     

The use of isoosmolar contrast medium for lowering of rate and clinical significance of contrast-induced nephropathy in patients with diabetes mellitus

As a contrast medium during percutaneous coronary intervention (PCI) we used iodixanol in 31 patients with diabetes mellitus and various degree of impairment of renal excretory function and amidotrizoate - in 12 patients with diabetes mellitus without clinical signs of renal involvement. Blood plasma creatinine (BPC) level was measured before and on days 3,5, and 10 after procedure. When iodixanol was used no significant differences of blood surem creatinine (BSC) levels before PCI and BPC levels before and on days 3,5,10 after PCI were obtained. When results of the use of iodixanol and amidotrizoate were compared pronounced advantage of iodixanol became evident (increment of BPC on days 3 and 5 after PCI were significantly higher in amidotrizoate group - 1,30 +/- 0,17 and 1,39 +/- 0,40 mg/dl, p=0,006; 1,33 +/- 0,19 and 1,42 +/- 0,41 mg/dl, p=0,016). Thus the use of iodixanol in patients with initial stages of chronic renal failure (with BSC 1,5 - 2,5 mg/dl) was sufficiently safe. The use of amidotrizoate in patients with diabetes mellitus even in the absence of signs of renal failure led to pronounced damage of the kidney which manifested as elevation of BPC levels on days 3, 5, and 10 after intervention.     

经皮冠状动脉介入术联合经皮血栓吸除术治疗急性心肌梗死的临床评价

目的 评价经皮冠状动脉介入术(PCI)联合经皮血栓吸除术治疗急性心肌梗死(AMI)的疗效.方法 56例AMI患者随机分为PCI组(n=28)和PCI联合血栓吸除术组(n=28).于PCI术后24小时、1周行实时心肌声学造影(RT-MCE),记录各组灌注对比积分指数(CSI)、室壁运动积分指数(WMSI)、透壁性对比缺损长度(CDL)和严重室壁运动异常长度(WML).采用免疫散射比浊法测定血浆超敏C-反应蛋白(hs-CRP)水平,酶联免疫吸附法测定血浆N-末端脑利钠肽(NT-ProBNP)和基质金属蛋白酶-9(MMP-9)水平.结果 各时间点PCI联合血栓吸除术组CSI、WMSI、CDL和WML明显低于PCI组(P＜0.05).术后1周PCI联合血栓吸除术组血浆hs-CPR和NT-ProBNP水平低于对照组[(4.56±1.98)mg/L比(5.96±2.03)mg/L,P＜0.05;(544.7±185.3)pmol/L比(897.6±215.9)pmol/L,P＜0.01],血浆MMP-9无明显升高[(672.7±175.9)μg/L比(609.6±196.5)μg/L,P＞0.05].结论 与PCI组相比,PCI联合经皮血栓吸除术可明显减少术后无再流的发生,改善微循环和心脏功能,是治疗AMI的有效方法.     

Renal failure after percutaneous coronary intervention is associated with high mortality.

Renal failure is a marker of poor outcome in the general population. Renal failure after percutaneous coronary artery intervention (PCI) is associated with an increased hazard of in-hospital mortality. We hypothesized that post-PCI renal insufficiency would be a predictor of long-term mortality in patients undergoing PCI who survive for over 30 days after the procedure. A retrospective analysis was conducted from a registry of 9,067 patients undergoing PCI at our center from 1997 to 2001. A rise in creatinine by 1 mg/dl from baseline was defined as post-PCI renal insufficiency. Vital status was assessed using Social Security Death Index. There were a total of 996 deaths over a mean follow-up period of 3.2 years. In a multivariate analysis, history of recent acute myocardial infarction, older age, insulin-dependent diabetes, baseline creatinine greater than 1.5 mg/dl, and presence of mitral regurgitation were associated with post-PCI renal insufficiency. Developing post-PCI renal insufficiency was associated with a 4.31-fold hazard of mortality in univariate analysis and a 1.77-fold hazard after adjustment for known predictors of mortality after PCI. The 1-year survival in patients with renal failure was 70.3% +/- 3.91%, compared to a survival of 93.6% +/- 0.27% in those without any post-PCI renal insufficiency (P < 0.0001). Acute renal insufficiency after PCI is a strong and independent predictor of long-term mortality in patients who survived for 30 days after the procedure.     

Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events.

AIMS: We investigated the role of asymmetric dimethylarginine (ADMA) for clinical outcome of patients with unstable angina. METHODS AND RESULTS: Forty-five patients with stable angina, 36 patients with unstable angina, and 40 healthy controls were included in this study. Coronary artery disease (CAD) patients were prospectively followed for 1 year. ADMA levels were measured at baseline and after 6 weeks using a validated ELISA. Baseline ADMA concentration in controls was significantly lower than in patients with CAD (0.59+/-0.23 vs. 0.76+/-0.17 micromol/L; P<0.001). Patients with unstable angina had significantly higher baseline ADMA levels than patients with stable angina (0.82+/-0.18 vs. 0.73+/-0.15 micromol/L; P=0.01). There was a significant reduction of ADMA levels at 6 weeks after percutaneous coronary intervention (PCI) in patients with unstable angina who experienced no recurrent cardiovascular event (from 0.81+/-0.14 to 0.73+/-0.19 micromol/L; P<0.05). In contrast, patients with unstable angina who had an event showed no significant decrease in ADMA at 6 weeks. Actuarial survival analysis showed a significantly higher event rate in patients with persistently elevated ADMA plasma concentrations. CONCLUSION: ADMA is significantly elevated in patients with unstable angina. A reduced ADMA level at 6 weeks after PCI may indicate a decreased risk of recurrent cardiovascular events.     

Lack of effect of percutaneous transluminal renal angioplasty on nocturnal hypotension in renovascular hypertensive patients

OBJECTIVE: To investigate whether nocturnal blood pressure fall is blunted in renovascular hypertension and can therefore be used as a diagnostic criterion for this condition. METHODS: In 14 renovascular hypertensive patients (age 43.8+/-2.1 years, mean+/-SEM, clinic blood pressure 173.6+/-3.7 mmHg systolic and 109.0+/-2.0 mmHg diastolic) and in 14 age- and blood pressure-matched essential hypertensive controls 24 h ambulatory blood pressure was measured after washout from drug treatment, during angiotensin converting enzyme inhibitor treatment and, in renovascular hypertension, also after percutaneous transluminal renal angioplasty. RESULTS: The 24 h average systolic and diastolic blood pressures were 146.4+/-5.7 and 97.5+/-3.6 mmHg in renovascular and 144.3+/-1.2 and 98.0+/-2.2 mmHg in essential hypertensive patients. The angiotensin converting enzyme inhibitor treatment reduced 24 h average systolic and diastolic blood pressures by 8.5% and 9.7% in the renovascular and by 8.3% and 10.8% in the essential hypertensive group. Greater systolic and diastolic blood pressure reductions (-18.2% and -18.1%) were observed in renovascular hypertensive patients after percutaneous transluminal renal angioplasty. Blood pressure fell by about 10% during the night and the fall was similar in renovascular and in essential hypertensive patients. In the former group, nocturnal hypotension was similar after washout, during angiotensin converting enzyme inhibitor treatment and after percutaneous transluminal renal angioplasty. Similar results were obtained for nocturnal bradycardia. CONCLUSIONS: Nocturnal blood pressure fall is equally manifest in renovascular and essential hypertension. The removal of the renal artery stenosis and blood pressure normalization do not enhance this phenomenon. Nocturnal hypotension seems therefore to be unaffected by renovascular hypertension.     

老年慢性肾功能不全患者冠状动脉介入治疗中连续性静静脉血液滤过预防对比剂肾病的效果

目的 观察和分析连续性静静脉血液过滤(continuous venovenous hemofiltration,CVVH)对老年肾功能不全患者行冠状动脉介入（PCI）治疗期间发生对比剂肾病（CIN）的预防效果。方法 回顾性分析我院60例肾功能不全行PCI的老年患者,按治疗肾功能不全的方法分为CVVH组（30例）与常规水化组（30例）。CVVH组术前4 h及术后18 h给予CVVH,常规水化组术前12 h及术后12 h给予生理盐水。检测两组患者术前和术后即刻、24 h、72 h和1 周的血肌酐,比较两组术后CIN的发生率。并随防6个月,观察和分析进入持续血透、非死亡心血管事件和死亡发生率。结果 两组患者临床特点无显著差异,PCI手术情况无显著差异。两组术后即刻、24 h、72 h和1周血肌酐比较有显著差异（P<0.05,P<0.01）。CVVH组CIN发生率7%,常规水化组30%,两组相比差异显著（P<0.05）。随访（5.6±1.2）个月,CVVH组需维持血透1例、常规水化组7例,CVVH组新发心血管事件1例,常规水化组6例,均有显著差异(P<0.05)。两组分别死亡1例和2例,病死率无显著差异。结论 对于老年肾功能不全的冠心病患者,PCI前后行CVVH可以显著减少CIN、维持血透及心血管事件的发生率。     

连续性静脉-静脉血液滤过治疗急性严重低钠血症六例

目的　观察连续性静脉 静脉血液滤过 (CVVH)治疗急性严重低钠血症的疗效。方法急性严重低钠血症 6例 ,基础病变分别为慢性肾功能衰竭 3例 ,急性肾功能衰竭、妊娠子痫及骨科手术后各 1例。所有患者血钠均低于 115mmol/L ,均为 4 8h内发生。采用中心静脉留置导管建立血管通路行CVVH。滤器为AN6 9及AV6 0 0各 2例 ,HF12 0 0及FH6 6各 1例 ,每 2 4h更换 1次 ,低分子肝素抗凝。结果　CVVH平均治疗时间为 5 9 7h。CVVH治疗中 ,患者血流动力学稳定 ,6例意识模糊者 ,5例治疗 12h后意识有所好转 ;3例嗜睡及谵妄者治疗 2 4h后症状消失 ;1例抽搐者治疗 2 4h后症状消失 ;1例昏迷者治疗 96h后神志完全恢复正常。CVVH治疗后 4 8h血钠上升至 (14 0 3± 1 6 )mmol/L ,纠正速度为 (0 82± 0 10 )mmol·L-1·h-1;血渗量水平为 (2 95 0± 4 2 )mOsm/kgH2 O ,纠正速度为 (1 6 3± 0 2 0 )mOsm·kgH2 O-1·h-1。CVVH开始置换液钠比血钠高 (16 0± 6 0 )mmol/L。CVVH治疗 4 8h后Glasgow评分较治疗前有显著升高 (P <0 0 5 ) ,APACHEⅡ评分较治疗前有显著降低 (P <0 0 5 )。 6例患者全部存活 ,3例转为维持性血液透析 ,3例完全康复。结论　CVVH治疗严重急性低钠血症是有效的 ,为严重急性低钠血症的救治提供了新的治疗     

持续肾脏替代治疗心源性休克并发急性肾功能衰竭

目的:总结10例心源性休克并发急性肾功能衰竭应用持续肾脏替代治疗的临床经验. 方法:2004年10月至2008年2月,对10例急性心肌梗死合并心源性休克并发急性肾功能衰竭患者应用持续肾脏替代治疗,所有患者都有难以控制的心源性休克,7例患者予急诊冠状动脉介入治疗,其中6例患者开通梗死相关血管;9例患者予气管插管,呼吸机辅助呼吸;1例患者予无创呼吸机辅助;10例患者均予主动脉内气囊泵辅助;患者均行深静脉穿刺,前稀释连续性静脉-静脉血液滤过.结果:持续肾脏替代支持72~480 h,平均216 h.6例患者顺利脱离持续肾脏替代治疗,5例存活,1例死亡;4例患者心源性休克不能纠正死亡.5例存活病例随访1个月~3年,均存活.结论:持续肾脏替代治疗可对心源性休克并发急性肾功能衰竭提供有效支持治疗,延长这部分高危患者的生命.     

心血管疾患伴发急性肾功能衰竭及多脏器功能衰竭的救治及预后

目的 回顾性分析心血管疾病伴发急性肾功能衰竭及多脏器功能衰竭的病因、治疗及预后。方法14例患者主要因急性心肌梗死、心肺复苏后、心脏手术后、冠状动脉造影后发生急性肾功能衰竭或多脏器功能衰竭,进行肾脏替代疗法。结果 14例患者5例存活,9例死亡,病死率64.3％;其中7例伴糖尿病者,6例死亡;急性心肌梗死后7例患者4例死亡,心脏手术后4例患者3例死亡;死亡主要与器官衰竭数目相关。结论心血管疾病伴发急性肾功能衰竭及多脏器功能衰竭经肾脏替代疗法及血流动力学监测,有助于体液平衡,稳定心血管系统,是安全有效的治疗方法。     

Renal, volume, and hormonal changes during therapeutic administration of recombinant interleukin-2 in man

Changes in blood pressure, renal function, and fluid balance were studied in 12 patients receiving intravenous recombinant interleukin-2 (IL-2) (100,000 units/kg every eight hours) over five days for treatment of metastatic melanoma and renal and colorectal cancers. The IL-2 regimen produced progressive hypotension, azotemia, and sodium avidity (fractional excretion of sodium = 0.20 +/- 0.07 percent) despite massive fluid administration (mean: 18.4 liter per five days) and weight gain (mean: 4.0 kg). Plasma renin activity rose. Hypoalbuminemia developed rapidly (3.6 +/- 0.1 g/dl to 2.2 +/- 0.1 g/dl, p less than 0.01) with widespread edema formation despite normal central venous pressures. Hematocrit did not change during the IL-2 period, consistent with a "capillary-leak." Hemodynamic and renal functional changes reversed after the IL-2 regimen was discontinued, but hypoalbuminemia and elevated urinary n-acetyl-glucosaminidase levels persisted after six days. These studies demonstrate widespread hemodynamic and vascular effects of IL-2 administration that limit its safe use and suggest a possible role for the lymphokine in mediating cardiovascular instability under other circumstances, such as endotoxic shock.     

Regular exercise training compared with percutaneous intervention leads to a reduction of inflammatory markers and cardiovascular events in patients with coronary artery disease

BACKGROUND: Chronic vascular inflammation may trigger ischemic events whereas regular physical exercise training (ET) has shown to be cardioprotective in patients with coronary artery disease (CAD). We investigated the impact of 2 years regular ET versus percutaneous intervention (PCI) on chronic inflammation and cardiovascular events. METHODS AND RESULTS: A total of 101 male patients with stable CAD and an indication for revascularization were prospectively randomized to regular ET (n=51) or PCI with stentimplantation (n=50). High-sensitive C-reactive protein and interleukin-6, exercise capacity and ischemic endpoints were analyzed at baseline and after 2 years. At 2 years maximal oxygen consumption (VO2 max) increased by 10% in the ET group (23.3+/-0.6 to 25.7+/-1.0 ml O2/kg/min; P=0.0171 versus baseline) versus 7% in the PCI group (22.3+/-0.8 to 23.9+/-1.2 ml O2/kg/min; P=0.4248). In a subgroup of patients, high-sensitive C-reactive protein levels and interleukin-6 levels were significantly reduced after ET by 41 and 18%, respectively, whereas no relevant changes were observed in the PCI group. Event-free survival rates after 24 months were 78% (ET) versus 62% (PCI) (P=0.039). CONCLUSION: In patients with stable coronary artery disease, regular physical exercise is associated with a reduction of inflammatory markers and ischemic events.     

Renal cell therapy in the treatment of patients with acute and chronic renal failure

Hemodialysis and hemofiltration have been important technologies in saving the lives of patients with acute (ARF) and chronic renal failure by clearing small solutes from plasma and thereby preventing death from acidemia, hyperkalemia, volume overload, and uremia. These therapeutic approaches, however, are still suboptimal, as patients with ARF have mortality rates exceeding 50%, and patients with end-stage renal disease (ESRD) have, on average, a life expectancy of 4-5 years. The preeminent cause of death in patients with ARF is the development of sepsis or the systemic inflammatory response syndrome with resulting systemic vasodilation, hypotension, ischemic injury to solid organs, multi-organ failure, and death. This vasodilation is due to persistent and excessive pro-inflammation. Similarly, the reduced survival times of patients with ESRD on chronic dialysis have been associated with a persistent and chronic systemic pro-inflammatory state. We have hypothesized that the loss of renal tubule cell mass acutely in acute tubule necrosis and chronically in ESRD results in an immunologically dysregulated state leading to excessive pro-inflammation. The replacement of renal tubule cell function may thus change the current dismal prognosis of patients with these disorders. In this regard, this report presents the first patient ever treated with a bioartificial kidney consisting of a synthetic hemofilter in series with a renal tubule assist device (RAD) containing approximately 10(9) human renal tubule cells. This treatment in a critically ill patient with multi-organ failure and ARF in the intensive care unit was associated temporally with improved cardiovascular parameters and enhanced native kidney function. Multiple systemic plasma cytokine levels and gene expression profiles of peripheral white blood cells were also temporally changed with cell therapy. Clinical trials in patients suffering from either ARF or ESRD are currently ongoing to evaluate the influence of the RAD on the inflammatory response in these groups of patients.     

连续性静脉静脉血液滤过在心脏手术后急性肾功能衰竭中的疗效及应用时机

目的 探讨连续性静脉静脉血液滤过(CVVH)在心脏手术后急性肾功能衰竭中的疗效及应用时机.方法 回顾性分析48 例心脏术后并发急性肾功能衰竭(ARF)患者的临床资料,按出现尿量减少(<0.5 ml·kg-1·h-1)至开始CVVH 治疗的时间间隔分为两组:A 组<4 h(27 例),B 组>4 h(21 例).分别对两组患者治疗前后的血尿素氮(BUN)、血肌酐(Cr)、胱抑素C(Cysc),以及CVVH 治疗时间、呼吸机使用时间、ICU 住院时间等指标进行比较.结果 两组患者经过CVVH 治疗后,BUN、Cr、Cysc 等指标均明显改善,两组间差异无统计学意义(P>0.05);A 组的CVVH 治疗时间、呼吸机使用时间、ICU 住院时间较B 组患者短,死亡率亦较B 组低,两组间比较差异有统计学意义(P<0.01).结论 CVVH 是治疗心脏术后急性肾功能衰竭的有效方法.及时诊断,尽早(出现少尿4 h 内)行CVVH 治疗,可明显加快ARF 患者肾功能恢复,减少并发症,减少住院时间,降低死亡率.     

连续性血液净化在ICU多器官功能障碍综合征合并急性肾衰竭患者的应用及预后分析

目的探讨连续性血液净化治疗（CBPT）在ICU多器官功能障碍综合征（MODS）合并急性肾衰竭（APF）患者的疗效及影响预后的相关因素。方法回顾性分析2004年1月至2008年2月该院ICU中行连续性静-静脉血液滤过（CVVH）治疗的245例MODS合并ARF患者一般资料、血液生化检查、疾病严重程度评分等，对比分析CVVH治疗前后临床参数的变化及影响预后的因素。结果CVVH对容量负荷、溶质清除效果明显；反映疾病严重程度如氧合指数、APACHEⅡ评分、MODS评分、SOFA评分CVVH治疗前后比较无明显差异；全部患者死亡率为64．9％，病死率随着衰竭器官数目的增加而显著升高。多因素回归分析显示，患者CVVH治疗前衰竭器官数、医院获得性ARF、CVVH前APACHEⅡ评分、平均动脉压是独立危险因素。结论对于MODS合并ARF患者，CVVH治疗前患者疾病的严重程度是影响预后的重要因素，依据患者临床病情早期积极CBPT可能改善MODS合并ARF患者的预后。     

急性心肌梗死患者PCI术后并发低血压和心律失常的危险因素

目的:探讨急性心肌梗死患者经皮冠脉介入治疗(PCI)术后并发低血压和心律失常危险因素。方法:行PCI的116例患者,根据术后是否并发低血压分为:低血压组(48例)和非低血压组(68例);是否并发心律失常分为:心律失常组(46例)和非心律失常组(70例)。比较各组基本资料,并分析急性心肌梗死患者PCI术后并发低血压或心律失常的危险因素。结果:与非低血压组比较,低血压组年龄、人体质量指数(BMI)、低血压病史、吸烟和饮酒比例均显著增加(P<0.05或<0.01);与非心律失常组比较,心律失常组年龄,BMI、心律失常病史、吸烟和饮酒比例均显著增加(P均<0.01)。对以上相关因素进行Logistic多因素分析,结果显示,急性心肌梗死PCI术后并发低血压的独立危险因素为年龄、BMI和低血压病史(OR=1.106~8.107,P<0.05或<0.01);并发心律失常的独立危险因素为年龄、BMI和心律失常病史(OR=1.106~11.452,P<0.05或<0.01)。结论:年龄、人体质量指数、低血压或心律失常病史是急性心肌梗死患者PCI术后合并低血压或心律失常的独立危险因素,对有这些危险因素的患者,应密切关注其血压及心律变化,进行相应的防治。