连续性血液透析滤过治疗在老年急性肾损伤中的应用体会

目的总结老年急性肾损伤（acute kidney injury,AKI）的临床特点并探讨连续性血液透析滤过（continuousvenovenous hemodiafiltration,CVVHDF）治疗抢救老年急性肾损伤的临床疗效及预后。方法20例患者均行CVVHDF及综合性治疗,其中AKIⅡ级5例,AKIⅢ级15例,并比较Ⅱ级组、Ⅲ级组之间治疗效果。结果20例治愈12例（60%）,有效3例（20%）,1例好转,4例死亡（20%）;〉50%患者有呕心、呕吐、心肌缺血等。CVVHDF治疗反应较好,Ⅱ级组治愈率高,肾功能恢复优于Ⅲ级组（P〈0.05）,少尿期短于Ⅲ级组（P〈0.05）,无明显不良反应。结论CVVHDF治疗抢救老年急性肾损伤患者成功率高,对复杂、高危性、高龄的AKI,尤其合并多器官功能障碍综合征（multiple organ dysfunctionsyndrome,MODS）者,提倡早期行CVVHDF治疗,同时重视基础疾病的治疗、营养支持、抗感染等综合治疗。

The treatment and comprehending of continuous venovenons hemodiafiltration in gerontal patients with acute kidney injury

Objective To summarize the clinical characteristics of elder patients with acute kidney injury（AKI）and explore the effect and prognosis of continuous venovenous hemodialysis filtration（CVVHDF）treatments for them.Methods Twenty elder patients with AKI were enrolled in this study,five patients in AKI stage 2 and fifteen patients in AKI stage 3,respectively.All of them were treated with CVVHDF and synthetic therapies,and we compared the different therapeutic effects of CVVHDF between the two groups.Results The main clinical manifestations of elder patients with AKI were proteinuria,oliguria and edema.95% patients were complicated with serious cardiac events including hypertension,shock,hypotension and arrhythmia.More than 50% patients had nausea,vomiting,myocardial ischemia and etc.Treatment with CVVHDF resulted in an excellent response,without any obvious toxic and side effects.Patients with AKI in stage 2 had a high cure rate.Results shown that the chance of recovery renal function in patients with AKI in stage 2 were superior to patients in stage 3（P〈0.05）.Furthermore,compared with patients in AKI stage 3,patients in AKI stage 2 had a shorter-time of oliguria period（P〈0.05）.Conclusion CVVHDF treatment strategy for elder patients with AKI can get a high survive rate.Early treatment should be performed in patients with severe conditions,existing high risk factors,aged,especially complicated with multiple organ dysfunction syndromes.At the same time,we should be emphasized the synthetic therapies：treatment of basic disease,nutritional support,anti-infection and so on.