连续性肾脏替代疗法在治疗伴急性肾衰竭的多器官功能障碍综合征中的应用

目的 :探讨连续性肾脏替代疗法 (CRRT)治疗伴急性肾衰竭 (ARF)的多器官功能障碍综合征(MODS)患者的临床疗效和影响预后的因素。方法 :应用 CRRT治疗 2 2例伴 ARF的 MODS患者 ,所有患者CRRT治疗前后均记录液体摄入量 ,每日检查血肌酐 (SCr)、尿素氮 (BUN )、血钾、血碳酸氢根浓度、动脉血p H;对 10例存活患者 (存活组 )和 12例死亡组患者 (死亡组 )的临床资料进行统计学分析。回顾分析应用间歇性血液透析 (IHD)治疗 17例伴 ARF的 MODS患者的液体摄入量 ,每日晨 SCr、BU N、血钾。结果 :CRRT组和IHD组每日液体摄入量分别为 (5 2 37± 10 6 ) m l和 (2 319± 87) ml(P<0 .0 5 )。 IHD组透析间期出现透析相关性低血压 13例次 ,发生容量依赖性心功能衰竭 8例次 ;而 CRRT组分别为 3例次及 1例次 (P均 <0 .0 1)。IHD组每日晨平均 SCr、BU N均高于 CRRT组 (P均 <0 .0 5 )。 IHD组和 CRRT组存活率分别为 35 .3% (6 / 17)和4 5 .5 % (10 / 2 2 ,P>0 .0 5 )。死亡组患者年龄更大 ,病情更重 ,需要机械通气患者数更多。结论 :CRRT控制伴ARF的 MODS患者酸碱平衡、液体平衡及氮质血症优于 IHD;伴 ARF的 MODS患者的预后与原发病、衰竭器官数、年龄等因素有关 ;CRRT可以改善危重 MODS患者的预后。

Continuous renal replacement therapy on patients of multiple organs dysfunction syndrome with acute renal failure

OBJECTIVE: To investigate the clinical effect of continuous renal replacement therapy (CRRT) on patients of multiple organ dysfunction syndrome (MODS) with acute renal failure (ARF). METHODS: Twenty-two MODS cases with ARF underwent CRRT. Blood urea nitrogen (BUN), serum creatinine (SCr), hydrocarbonic, serum potassium, and artery blood pH were detected in all patients every morning after hemopurification, in all patients volumes of infused fluid were recorded. The experience in 17 MODS cases with ARF treated with intermittent hemodialysis (IHD) in our hospital before October 1999 was present. RESULTS: The volumes of infused fluid were (5,237+/-106) ml and (2,319+/-87) ml in CRRT and IHD group respectively (P<0.05). In IHD group, 8 cases had cardiac failure between two hemodialysis sessions, and 13 cases had hypotension during hemodialysis; but in CRRT group there were only 1 and 3 cases respectively (both P<0.01). Mean levels of above BUN, SCr in IHD group were significantly higher than those in CRRT group (both P<0.05). The survival rates were 35.3% (6/17) and 45.5% (10/22) in IHD and CRRT group respectively, in the survival group, there were significantly less need of mechanical ventilation and vasoactive supporting. CONCLUSION: CRRT has benefits in improving fluid balance, acid-base balance and asotemia beyond IHD. The patient's age, need of mechanical ventilation and vasoactive drugs are predictors of a worse prognosis in patients of MODS with ARF. The prognosis of MODS with ARF is improved with CRRT.