40例多器官衰竭时急性肾功能衰竭的临床分析

目的：探讨多器官衰竭（ＭＯＦ）时急性肾功能衰竭（ＡＲＦ）的更为有效的防治手段，防止和阻断其进一步发展，改善ＭＯＦ的预后。方法：对４０例ＭＯＦ合并ＡＲＦ的病例资料进行临床分析。结果：ＭＯＦ的主要原发病因是感染（７０．０％），其次是创伤（２２．５％），其它占７．５％；本组患者的病死率６５．０％，且随衰竭器官的数目增多而病死率升高。ＡＲＦ表现为少尿型８７．５％，非少尿型１２．５％。采用血液透析（ＨＤ）治疗２２例中存活１２例，死亡１０例，病死率５４．５％；非ＨＤ治疗１８例中存活２例，死亡１６例，病死率８８．９％，比较此两种治疗方法的疗效ＨＤ组明显高于非ＨＤ组（Ｐ＜０．０１）。结论：对于ＭＯＦ时ＡＲＦ的治疗，首先应针对各器官衰竭的治疗；积极有效地控制感染是抢救成功的关键；早期充分的血液净化是治疗的重要环节；辅助支持疗法，提高免疫功能，改善组织缺氧，禁止应用对肾脏有损害的药物，对改善本病的预后具有重要意义。

Clinical analysis of acute renal failure in 40 patients with multiple organ failure

Objective:To investigate the effective methods to treat acute renal failure (ARF) in patients with multiple organ failure (MOF),preventing development of MOF and improving prognosis in those patients.Methods:Clinical analysis of acute renal failure in 40 patients with MOF were included in this study.Results:Infection was the major primary cause of MOF (70 0%),and severe trauma ranked next (22 5%),and other causes 7 5%.The mortality rate was 65 0% and it increased as the number failed organs increased.ARF with oliguria and nonoliguria constituted 87 5% and 12 5% of all cases,respectively.Mortality rate were 54 5% (10/22) in hemodialysis group,88 9%(16/18) in nonhemodialysis group,and the difference was significant( P <0 01).Conclusions:These results suggest that it is important to support vital organ function and effectively control infection in the treatment of ARF in patients with MOF.In addition to accessory treatment,which would ameliorate immune function and tissue hypoxia,early hemodialysis may play a significant role in reducing mortality and improving prognosis in those patients.