| CRRT在抢救MODS中的应用 |
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| 引用本文： | 成小苗,周巧玲,邓声莉,陈立平,张军. CRRT在抢救MODS中的应用[J]. 中南大学学报(医学版), 2006, 31(4): 580-583 |
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| 作者姓名： | 成小苗 周巧玲 邓声莉 陈立平 张军 |
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| 作者单位： | 中南大学湘雅医院肾脏内科,长沙,410008;中南大学湘雅医院肾脏内科,长沙,410008;中南大学湘雅医院肾脏内科,长沙,410008;中南大学湘雅医院肾脏内科,长沙,410008;中南大学湘雅医院肾脏内科,长沙,410008 |
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| 摘 要： | 目的：观察连续性肾脏替代治疗（continuous renal replacement therapy，CRRT）对危重症患者的疗效。方法：患者分为CRRT组（A组）和普通透析组（B组）。A组7l例多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）患者进行175台次CRRT，B组30例慢性肾功能衰竭患者进行普通血液透析。患者在治疗前后分别抽血检测尿素氮（BUN）、肌酐（Scr）、血钾、血钠、血氯、二氧化碳结合力（CO2 CP）、pH，HCO3^-，PCO2和PO2等指标，分析治疗前后各指标的改变。结果：所有患者治疗后一般情况、水电解质和酸碱紊乱情况得到改善。组内比较显示，患者治疗后BUN，Scr，血钾（均P〈0．01）、血钠均下降（A组P〈0．05，B组P〈0．01），C02CP升高（A组P〈0．01，B组P〈0．05）。组间比较显示，BUN，Scr，血钾（均P〈0．01）、血氯、CO2CP（均P〈0．05）有明显的差异，表明A组的疗效比B组更佳。另外，A组30例伴急性呼吸窘迫综合征（ARDS）的患者经过CRRT后pH，PO2和HCO3^-明显上升（P〈0．01），PCO2明显下降（P〈0．05），CRRT后患者的生存时间明显延长。9例中毒患者使用CRRT加血液灌流，有7例完全缓解，2例死亡。对于有出血倾向或术前48h的患者使用肝素浸泡血液滤器法后，没有发生出血或出血加重的情况。结论：CRRT与普通透析相比，在清除毒素和纠正电解质酸碱失衡方面疗效更佳，对提高患者PO2、减轻CO2潴留，改善脑水肿和肺功能效果明显，MODS患者的死亡率很高，早期使用CRRT治疗对抢救MODS等危重症和改善患者预后起着积极有效的作用。
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| 关 键 词： | 连续性肾脏替代治疗 多器官功能障碍综合征 全身炎症反应 |
| 文章编号： | 1672-7347（2006）04-0580-04 |
| 收稿时间： | 2005-10-09 |
| 修稿时间： | 2005-10-09 |
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| CHENG Xiao-miao,ZHOU Qiao-ling,DENG Sheng-li,CHEN Li-ping,ZHANG Jun.
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| Authors: | CHENG Xiao-miao ZHOU Qiao-ling DENG Sheng-li CHEN Li-ping ZHANG Jun |
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| Affiliation: | Department of Nephrology, Xiangya Hospital, Central South University, Changsha 410008, China. cxm6131@yahoo.com.cn |
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| Abstract: | OBJECTIVE: To investigate the effect of continuous renal replacement therapy (CRRT) on patients with emergency and serious diseases. METHODS: The patients were divided into 2 groups: Group A [71 patients with multiple organ dysfunction syndrome (MODS)] were treated by CRRT for 175 times. Group B (30 patients) were treated with common hematodialysis (HD). Blood urea nitrogen (BUN), serum creatinine (Scr), natrem (Na(+)), kalium (K(+)), chlorine (Clj), power of hydrogen (pH), bicarbonate (HCO3-), carbon dioxide partial pressure (PCO(2)), and oxygen pressure (PO(2)) were measured before and after the treatment. RESULTS: After the treatment, all patients' general state of health, water-electrolyte and acid base disorder were improved. The levels of BUN, Scr, K(+) (All P(s)<0.01), and Na(+) (P<0.05 in Group A, P<0.01 in Group B) were all lower and the levels of CO(2)CP (P<0.01 in Group A, P<0.05 in Group B) were higher than that before the pretherapy in both Group A and Group B. There was significant difference on the levels of BUN, Scr, K(+)(All P(s)<0.01), Cl(-) and CO(2)CP (All P(s)<0.05) between Group A and Group B, which indicated the therapeutic effect in Group A was better than that in Group B. Furthermore, the levels of pH, PO(2) and HCO(3)(-) were higher (P<0.01) and PCO(2) was lower (P<0.05) obviously than that before the CRRT in 30 patients with acute respiratory distress syndrome (ARDS) in Group A. Among the 9 patients with poisoning, 7 were alleviated completely and 2 died after the CRRT plus hemoperfusion (HP). The survival time of patients was lengthened in Group A. No blood or bleed aggravation occurred in patients with bleeding inclination or 48 h before the operation after using the method of heparin soaking the blood filter. CONCLUSION: CRRT has better curative effect on removing the toxin effectively, rapidly correcting the turbulence of water electrolyte and sour-alkali balance for patients compare with HD. At the same time, it can increase the level of PO(2) and reduce CO(2) retention, improve the lung function and brain edema, and increase the patient's survival rate. Using CRRT as early as possible is very important and it can improve the prognosis of the patients who had MODS or other dangers because the death rate of MODS patients is very high. |
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| Keywords: | continuous renal replacement therapy multiple organ dysfunction syndrome systemic inflammatory responses syndrome |
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