持续性肾脏替代治疗联合血浆置换在危重患者中的应用

目的观察持续性肾脏替代治疗（CRRT）联合血浆置换（PE）救治危重患者的临床疗效,并与血液透析或血液透析滤过进行比较。方法 60例危重症患者根据治疗方式的不同分为观察组和对照组,观察生化指标及临床疗效。结果两组治疗后血清BUN、Cr、和K＋均较治疗前降低（P均〈0.01）;观察组治疗后CIC、CK、ALT、AST、LDH和D-Di均较治疗前下降（P〈0.01）,且下降幅度与对照组有统计学差异（P〈0.05）;观察组显效率和总有效率高于对照组（P均〈0.05）。结论通过CRRT持续恒定地清除中小分子毒素、纠正水电解质酸碱平衡紊乱,并对于危重患者联合PE治疗可清除大分子毒素,可为临床危重患者抢救提供更多的手段和措施。

Application of combining continuous renal replacement therapy with plasma exchange in critically ill patients

Objective To observe the clinical efficacy of treatment combining continuous renal replacement therapy（CRRT） with plasma exchange（PE） in critically ill patients and do comparison with hemodialysis or hemodiafiltration.Methods A total of 60 critically ill patients were divided into observation group and comparison group.Then the biochemical markers and clinical efficacy were observed.Results After treatment,serum BUN,Cr,and K＋ in the two groups were significantly decreased（P〈0.01）;After combining CRRT with PE treatment,CIC,CK,ALT,AST,LDH,and D-Di were significantly lower（P〈0.01）,and the decrease range was significantly higher than that in comparison group（P〈0.05）.Conclusion Combined with PE,it can remove big molecule toxins by CRRT continuously and constantly removing small molecule toxins,correcting acid-base balance of water electrolyte disorders for critically ill patients,which can provide more tools and measures for clinical patients in an emergency.