床边间歇性血液透析在重症监护病房的应用

目的探讨我院自行研发的床边透析技术在重症监护病房进行间歇性血液透析(intermittent hemodialysis,IHD)的治疗效果。方法回顾性分析我院2005年5月至2009年5月间在重症监护病房行床边间歇性血液透析患者88例,记录治疗前后APACHEⅡ积分、ATN-ISI积分、Boston心力衰竭积分、二氧化碳结合力(CO2CP)、氧合指数、床边透析次数及透析后住院天数。对死亡组与生存组及ARF组与CRF组分别行统计学分析。结果 IHD治疗后APACHEⅡ积分、Boston积分、Scr、CO2CP明显改善(P0.05)。治疗后死亡49例,生存39例;生存组年龄较小,手术后患者更多(P0.05)。治疗前后,死亡组的APACHEⅡ积分、死亡预测值、ATN-ISI积分均较生存组高(P0.05)。ARF患者54例,CRF患者34例。CRF组的年龄、床边透析次数、心衰人数、糖尿病人数均高于ARF组(P0.05)。治疗前后,ARF组的APACHEⅡ积分均高于CRF组,而Boston积分、Scr较低(P0.05)。患者死因及ARF患者入住ICU的首要病因主要为败血症、脑血管意外、冠心病及心肺复苏后,CRF患者主要为心衰、肺部感染、糖尿病。结论我院床边IHD利于危重患者病情好转。当危重患者血流动力学稳定时,床边IHD是优先选择的治疗方法。只要使用合适的透析设备和合理的治疗方案I,HD仍是治疗合并急、慢性肾功能衰竭危重患者的良好选择。

The Application of Bedside Intermittent Hemodialysis in Intensive Care Unit

Objective To investigate the effect of bedside intermittent hemodialysis（IHD） which was developed byour hospital in intensive care unit（ICU）.Methods 88 patients treated by bedside IHD in ICU between May 2005 and May 2009 were studied.APACHEⅡ（acute physiology and chronic health evaluation） score,ATN-ISI（acute tubular necrosis-individual severity index） score,score of Boston criteria for diagnosing heart failure,carbon dioxide combining power（CO2CP）,oxygenation index（PaO2/FiO2）,the number of dialysis and length of stay in the hospital after IHD were recorded.Statistical analysis were made both between death group and surviaval group,acute renal failure（ARF） group and chronic renal failure（CRF） group.Results APACHEⅡscore,score of Boston criteria,Scr,CO2CP were improved after the treatment of bedside IHD（P〈0.05）.49 patients died and 39 patients survivid,the survivors were younger and more persons with operations（P〈0.05）.APACHEⅡscore,predicted death rate,ATN-ISI score in death group were higher before and after IHD（P〈0.05）.54 patients were with AFR while 34 with CRF.There were significant differencesn age,the number of dialysis and the number of patients with heart failure or diabetes（P〈0.05） between two groups.APACHEⅡscore was higher,score of Boston criteria and Scr were lower in ARF group before and after IHD（P〈0.05）.The causes of death and principal reasons of patients with ARF for ICU admission were sepsis,cerebral vascular accident,coronary heart disease and cardiopulmonary resuscitation however patients with CRF were heat failure,pulmonary infection and diabetes.Conclusion Bedside IHD in our hospital is beneficial to severe patients.Once hemodynamic stability is attained,IHD should be the preferred modality.If the equipment for dialysis is appropriate and therapeatic plan is rational,IHD will be a good choice for severe patients with ARF or CRF.