大器官移植术中和术后连续性肾脏替代治疗(CRRT)的应用

目的 探讨肝脏移植、心脏移植、肾脏移植、心肾联合移植、肝肾联合移植、胰肾联合移植等大器官移植及联合器官移植术中术后出现肾功能损害及多器官功能衰竭时，采用连续性肾脏替代治疗(CRRT)的方法和对人／移植物存活率的影响。方法 应用PRISMA(Hospal)机器或AK-10(Gambro)单泵机与3台Baxter 6201型流量泵并用，行SCUF、CVVH、CVVHD、CVVH-DF，治疗大器官移植术中术后出现肾功能损害及多器官功能衰竭共51例次。结果 全部病例CRRT治疗期间生命体征、血流动力学稳定。治疗6h后电解质及血气明显改善。治疗48h，各脏器功能稳定，大部分移植物功能逐渐恢复。结论 CRRT救治大器官移植术中术后出现肾功能损害及多器官功能衰竭可明显提高人／移植物存活率，是大器官移植术中及术后良好的肾脏支持方式.

Application of continuous renal replacement therapy in solid organ transplantation

Objective To evaluate the outcome in patients with acute renal failure(ARF) and multiple organ dysfunction syndrome(MODS) during or following solid organ transplantation receiving continuous renal replacement therapy(CRRT).The methods of CRRT in these patients are also investigated.Methods 36 cases include liver transplantation 18 cases,liver kidney transplantation 2 cases,heart transplantation 3 cases, combined heart and kidney transplantation 1 case, renal transplantation 12 cases, simultaneous pancreas kidney transplantation 1 case, who are complicated with ARF or MODS during and post operation. All of these patients were treated with CRRT 51 times. The PRISMA system (Hospal)or AK 10(Gambro system)cascade with Baxter 6201 type flow pump were used for slow continuous ultrafiltration(SCUF), continuous venovenous hemofiltration(CVVH), continuous venovenous hemodialysis(CVVHD),continuous venovenous hemodiafiltration(CVVHDF).Results All of these patient's vital signs and hemodynamics were stable during CRRT. Electrolyte and blood gas analysis ameliorated obviously after CRRT 6 hours. The function of vital organs were stable and much of graft function were normal following CRRT 48 hours. The long term survival rate of liver transplantation, heart transplantation, and renal transplantation complicated ARF and MODS receiving CRRT were 71.4%(14/18 cases),100%(3/3),and 91.6%(11/12),respectively.Conclusion CRRT can remarkably improve human/graft survival rate of solid organ transplantation complicated with ARF and MODS during and post operation. It is an important method of renal and other vital organ support in transplantation.