不同透析方法治疗颅脑外伤合并急性肾功能衰竭

目的　探讨不同透析方法治疗颅脑外伤合并急性肾功能衰竭 (ARF)的疗效。方法　颅脑外伤合并ARF行血液净化治疗患者共 4 3例 ,分为三组 ,血液滤过 (HF)组 14例 ,腹膜透析 (PD)组 13例 ,连续性肾脏替代治疗 (CRRT)组 16例。结果　HF组死亡率 71.4 % ,明显高于PD组的 30 .8%及CRRT组的 5 .0 % ,P <0 .0 5。HF组透析中脑脊液压力升高幅度及血浆渗透压下降幅度与CRRT及PD组比较差异显著 ,P <0 .0 5 ;CRRT组透析相关性出血率为 5 6 .3% ,HF组为 2 8.6 % ,PD组为 7.7% ,三组间透析相关性出血率有显著差异 (P <0 .0 5 )。透析相关感染的发病率 ,三组间无显著差异。结论　PD及CRRT治疗颅脑外伤并发急性肾功能衰竭优于血液滤过 ,但也应当注意预防感染及出血 ,并根据具体情况选择 ,早期治疗 ,提高生存率。

The effect investigation of different dialysis methods on treating acute renal failure complicated by cerebral trauma

Objective To discuss the effect of different dialysisi methods on treating acute renal failure complicated by cerebral trauma. Methods The 43 patients we rerandomly divided into three groups: HF group(14 cases),PD group(13 cases) and CRRT (16 cases)group. Results The mortality rate in HF group was 71.4%, which was statisticly higher than the rate in PD(30.8%) and CRRT(25.0%) group,P<0.05. The bleeding rate related with dialysis was 56.3% in CRRT group, 28.6% in HF group, and 7.7% in PD group, there was a statistical difference among the three groups. The changes of cerebral fluid pressure and the plasma osmotic pressure in HF group was statisticly different from the change in PD and CRRT group. The infectious rate related with dialysis had no difference among the three groups. Conclusion The treatment of acute renal failure complicated by cerebral trauma with PD and CRRT were better than HF, but the bleeding and infection should be pay attention to, early treatment can improve the surviral rate.