腹膜透析治疗多脏器功能衰竭急性肾损伤12例临床分析

目的研究腹膜透析对多脏器功能衰竭并急性肾损伤的疗效。方法回顾12例多脏器功能衰竭并急性肾损伤患者行持续非卧床腹膜透析治疗的临床资料,分析腹膜透析前后血钾离子（K^＋）、碳酸氢根（HCO3^-）、血尿素氮（BUN）、血肌酐（SCr）、血压及尿量等水平的变化,探讨腹膜透析治疗AKI的安全性及有效性。结果本组12例,其中男性9例,女性3例,年龄9-77岁,平均年龄52.1岁。原发病：颅脑损伤1例,脑血管意外3例,心脏瓣膜置换术后1例,肾移植术后1例,溶血尿毒综合征（HUS）1例,狼疮性肾炎1例,急性重症胰腺炎（SAP）4例,其中儿童患者1例。AKI分期：AKIⅡ期3例,AKIⅢ期9例。本组患者的转归与发生功能障碍的器官数目有关,2个器官功能障碍6例,存活6例（存活率100%）,3个器官功能障碍4例,存活3例（存活率75%）;3个以上器官功能障碍2例,存活1例（存活率50%）。7例患者脱离透析治疗,3例患者继续维持性PD。本组存活率为83.3%。腹膜透析1周后,血尿素及肌酐控制在满意水平,水电解质及酸碱平衡紊乱纠正,生命体征较前稳定,腹膜透析超滤量1400-2400 ml,平均2100 ml。结论腹膜透析对多脏器功能衰竭并急性肾损伤具有满意的疗效,患者的预后主要取决于器官衰竭数目及原发病。

Clinical analysis of peritoneal dialysis for 12 cases of acute kidney injury with multiple organ dysfunction syndrome

Objective To evaluate the therapeutic effect of peritoneal dialysis（ PD） for acute kidney injury（ AKI） with multiple organ dysfunction syndrome（ MODS）. Methods The clinical data of 12 cases of AKI with MODS undergoing continuous ambulatory peritoneal dialysis（ CAPD） were reviewed. The changes of K^＋,HCO3^-,BUN,Scr,BP and UV were compared before and after PD. The efficacy and safety of PD for AKI with MODS was discussed. Results Total 12 patients included 9 male and 3 female,aged 9- 77 with an average age of 52. 1 years old. The primary disease： 1 case of traumatic brain injury,3 cases of cerebrovascular accident,1 case after heart valve replacement,1 case after renal transplantation,1 case of hemolysis urine toxin syndrome（ HUS） in,1 case of lupus nephritis,4 cases of acute severe pancreatitis（ SAP）,in which 1 case was children. AKI stages： AKI Ⅱ period 3 cases,AKI Ⅲ period 9 cases. In all 12 patients,6cases were with 2-organ dysfunction and all survived（ 100%）,4 cases were with 3-organ dysfunction and 3 patients survived（ 75%）; 2 cases were with more organ dysfunction and 1 patient survived（ 50%）. 7 patients had stopped the dialysis treatment,while 3 patients continued PD. The total survival rate was 83. 3%. One week after PD,the levels of blood urea nitrogen and creatinine was controlled at a satisfactory level,electrolyte and acid-base balance disorders corrected,vital signs was stable than before. Conclusion PD has better therapeutic effects for AKI with MODS. The prognosis of AKI patients mainly depends on the primary disease and the number of failed organs.