持续肾替代治疗在心脏术后急性肾功能衰竭的早期应用

目的探讨早期持续肾替代治疗（CRRT）在体外循环术后并发急性肾功能衰竭患者的救治作用.方法通过对32例体外循环术后并发急性肾功能衰竭患者采用床旁血液净化系统,行前稀释连续性静脉-静脉血液滤过（CVVH）,肝素抗凝,观察治疗前和治疗后肾功能指标（Bun、C）r、血钾、平均动脉压（MAP）、中心静脉压（CVP）、左室射血分数（EF）、氧和指数（PaO2/FiO）2等指标.当尿量〉0.5mL/（kg.h）,且循环功能平稳后停止CRRT.结果 32例患者存活25例,其中1例肾功能未恢复需间歇透析治疗,其余24例肾功能均恢复正常,死亡7例,病死率21.7%.CRRT治疗前后Bun、Cr、血钾、MAP、CVP、EF、氧合指数均有明显改善（P〈0.05）.结论早期行CRRT对体外循环术后急性肾功能患者有较好疗效,掌握好恰当的时机和方法能明显降低病死率。

The Early Application of Continuous Renal Replacement Therapy in Acute Renal Failure after Cardiac Surgery

Objective Toinvestigate the effect ofcontinuous renal replacement therapy（CRRT） for acute renal failure after cardiac surgery.Methods Thirty-two patients who underwent heart operation required renal replacement therapy beside the bed.Early diluted continuous veno-venous hemofiltration（CVVH）.Heparin was used for anti-coagulation.Before and after the treatment,serum levels of blood urea nitrogen（BUN）,creatinine（C）r,potassium,mean arterial pressure（MAP）,central venous pressure（CVP）,left ventricle ejection fraction（EF）,oxygenation index（PaO2/FiO）2 were evaluated.CRRT was stopped when urine volume0.5 mL/（kg.h） and circulatory function was stable.Results 25 patients survived in the 32 patients.The renal function was not recovered in one patient who need dialysis therapy,and recovered in the other 24 patients.7 patients died,the death rate was 21.7%.Bun,Cr,potassium,MAP,CVP,EF,PaO2/FiO2（P〈0.05） were improved obviously after CRRT（P〈0.05）.Conclusion The early application of CRRT has good effect on acute renal failure after cardiac surgery,good opportunity and method can decrease mortality.