吸附法无肝素血液透析在急性肾功能衰竭救治中的应用  

Application of heparinfree hemodialysis of absorption in acute renal failure

作　　者：王淑芬[1] 杜娟[1] 李冀军 钦军 吕恒华 

机构地区：[1]解放军三○四医院肾内科

出　　处：《中国危重病急救医学》1997年第5期274-275,共2页Chinese Critical Care Medicine

基　　金：全军医药卫生科研基金

摘　　要：目的：探求对合并活动性出血的急性肾功能衰竭（ＡＲＦ）患者的正确救治方法，以逆转患者病程，提高存活率。方法：对１０例合并活动性出血的ＡＲＦ患者应用吸附法无肝素血液透析（ＨＦＨＤ）７５例次。结果：透析器有凝血现象６例次（凝血发生率８％），全部病例血液透析（ＨＤ）后出血停止；血尿素氮（ＢＵＮ）、肌酐（Ｃｒ）较ＨＤ前显著下降；纠正了水、电解质和酸碱失衡、症状改善；临床治愈５例，好转２例，院内死亡２例，出院后死亡１例。结论：ＡＲＦ的预后与ＨＤ前ＢＵＮ、Ｃｒ、出血量无关，而与ＡＲＦ病因、患者的身体基础情况、开始治疗时间和合并脏器衰竭的数目密切相关。吸附法无肝素血液透析的生物相容性好，ＨＤ效果确切，简便、安全，不影响患者的凝血机制，不干扰ＨＤ中的治疗操作。对救治合并多脏器功能不全及可疑有出血倾向的ＡＲＦ患者应用为宜。Objective:To study effective method in the treatment of acute renal failure (ARF) patients with hemorrhage.Methods:The heparinfree hemodialysis (HFHD) of absorption had been used in ten ARF patients with hemorrhage for 75 times.Results:The dialyzer coagulation was developed for six times within 75 times (8%),and hemorrhage was stopped in all patients after hemodialysis (HD).Blood urea nitrogen (BUN) and creatinine(Cr) were significantly decreased after HD in comparison with pretreatment values.Moreover,acidbase imbalance was corrected and patient's symptom was remarkably improved.Among ten ARF patients,five cases were cured together with improvement in two cases,death in two cases and leave in one case.Conclusions:The prognosis of ARF is not related to pretreatment BUN,Cr values and amount of bleeding,but it is closely associated with the cause of ARF,individual physical condition,beginning time of treatment and number of failed organs.Absorption method HFHD has many advantages,such as good bioconcomitance,satisfying effect,easy operation,safety and noninterference with coagulation mechanism.The HFHD method is suitable for the ARF patients complicated by multiple system organ dysfunction and hemorrhage.

关 键 词：肾功能衰竭 血液透析 吸附法 无肝素 

分 类 号：R692.505[医药卫生—泌尿科学] R459.5[医药卫生—外科学]