连续性血液净化救治心脏术后重症肾衰竭的疗效分析

目的探讨连续性血液净化（CBP）治疗心脏术后重症急性肾衰竭（ARF）的效果和时机选择。方法31例行CBP治疗的重症ARF患者分为生存组（A组）和死亡组（B纽）。观测两组治疗前后平均动脉压（MAP）、氧舍指数（PaO2／FiO2）、肾功能（Cr、BUN）、MODS评分和APACHEⅡ评分；比较2组CBP距ARF和尿量〈0．5ml／（Kg·h）时间。结果CBP前B组MODS评分、APACHEⅡ评分均明显高于A组；CBP后，仅A组MODS评分、APACHEⅡ评分下降；CBP后2组Cr、BUN降低，MAP、PaO2／FiO，升高；B组的CBP距ARF和尿量〈0．5ml／（Kg·h）时间长于A组（P均〈0．05）。结论CBP治疗心脏术后重症ARF是安全有效的，尽早行CBP有利于改善患者预后。

The therapeutic efficacy of continuous blood purification for severe acute renal failure after cardiac surgery

Objective To evaluate the efficiency and the timing of continuous blood purification(CBP) in patients with multiple or-gan dysfunction syndrome(MODS) and acute renal failure(ARF) following cardiac surgery. Methods From November,2003 to July,2007,thirty-one patients with MODS and ARF following cardiac surgery were treated with CBP. They were divided into two groups, alive group ( group A) and dead group ( group B). Clinical data of the two groups were reviewed. Before CBP, duration of extracorporeal circulation, du-ated. Mean arterial pressure (MAP), heart rate (HR), oxygenic index (PaO2/FiO2), white blood cell count (WBC), platelet count (PLT) and renal function (blood urea nitrogen, BUN, ercatinine, Cr) were observed before and after CBP. Results The number of im-paired organs of patients in group B was significantly more than that in group A before CBP ( P＜0.05). MODS scores ( 12.9±3.2 vs 6.9 ±2.3, P＜0.05) and APACHE Ⅱ scores (26.3±10.4 vs 17.2±5.1, P＜0.05)of group B were significantly higher than those of group A before CBP. After treatment of CBP for 24 hours, APACHE Ⅱ scores and MODS scores only significantly decreased in group A (P＜0.05 ). After treatment of CBP, Cr and BUN significantly reduced, while MAP and PaO2/FiO2 increased, in all patients, but HR was signif-icantly lower than that before CBP in group A (P＜0.05). The duration of ARF (34.67±32.79 hours vs 13.05±14.09 hours,P＜cantly higher than those of group A. Conclusion MODS scores and APACHE II scores can be used to evaluate the severity of patients with MODS and ARF after cardiac surgery. CBP is an effective treatment for these patients. It is suggested that early CBP therapy is important for reducing the chances of the multiple organ dysfunction syndrome and mortality of these patients.