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.

The effect and application occation of continuous veno-venous hemofiltration in acute renal failure after heart surgery

Objective To study the curative effect and application occation of continuous veno-venous hemofihration（CVVH） in acute renal failure after heart surgery. Methods The clinical data of 48 patients with acute renal failure （ARF） after heart surgery were collected and analyzed retrospectively. According to the time in- terval between hypourocrinia（〈0.5 ml·kg^-1·h^-1） occurrence and start CVVH therapy initiation, all subjects were di- vided into two groups： group A, 〈4 h（n=27） and group B〉4 h （n=21）. We respectively compared with the blood urea nitrogen （BUN）, serum creatinine（Cr）, eystatin C （Cyse） before and after treatment in the both groups of pa- tients; then compared with the CVVH therapy time, breathing machine time, and ICU hospitalization time. Results The BUN, Cr, Cysc and other indicators in both groups of patients were improved after CVVH therapy, but has no significant difference（P〉0.05 ）. The CVVH therapy time, breathing machine use time, ICU hospital time in group A were shorter than group B （P〈0.01）, the mortality of group A was also lower than group B （P〈0.01）. Conclusion CVVH is an effective treatment of acute renal failure patients after heart surgery. Early diagnosis and treatment （to start CVVH within 4 hours after the upset of hypourocrinia） can obviously accelerate the recovery of patients with ARF and reduce complications, hospitalization time and lower mortality.