连续性静-静脉血液透析滤过在心脏外科手术后重症急性肾衰竭的应用  

Application of continuous veno-venous hemodiafiltration to severely acute renal failure after cardiac surgery

作　　者：张萍[1] 左祥荣[1] 曹权[1] 徐鑫荣[1] 

机构地区：[1]南京医科大学第一附属医院1CU,210029

出　　处：《中国急救医学》2008年第2期158-160,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的研究连续性静-静脉血液透析滤过(continuous veno-venous hemodiafiltra-tion,CVVHDF)在心脏术后重症急性肾衰竭(acute renal failure,ARF)中应用的疗效。方法回顾分析20例心脏术后重症ARF患者采用CVVHDF治疗,比较治疗前后血尿素氮(BUN)、肌酐(Cr)、氧合指数(PaO2/FiO2)、APACHEⅡ评分和电解质(K+、Na+及Cl-)的变化,以及CVVHDF过程中血流动力学:心率(HR)、平均动脉压(MAP)及中心静脉压(CVP)的变化。结果12例存活,8例死亡。CVVHDF治疗后BUN、Cr和血清K+、Na+及Cl-明显下降,而且CVVHDF过程中MAP显著上升,CVP显著下降(与治疗前比较,差异有统计学意义,P<0·05),HR变化不大。结论CVVHDF是治疗心脏外科手术后重症ARF的一种有效、方便而安全的方法。Objective To evaluate the effect of continuous veno - venous hemodiafiltration （ CV- VHDF ） on severely acute renal failure following cardiac surgery. Methods From January 2004 to December 2006,20 patients with severely acute renal failure following cardiac operation received CVVHDF. Before and after the treatment, serum levels of blood urea nitrogen （ BUN ） , creatinine （ Cr ） , oxygenation index （ PaOE/FiO2 ） , APACHE Ⅱ scores, and electrolytes such as potassium, sodium, chlorine were evaluated. Mean arterial pressure （ MAP） , heart rate （ HR） , central venous pressure （ CVP） were observed at scheduled intervals. Results 12 patients survived and eight died during the course of treatment. There were obvious changes in BUN, Cr,APACHE Ⅱ scores, PaO2/FiO2, K^＋, Na^＋, Cl^-, MAP, and CVP after CVVHDF （ P 〈 0.05 ） , while there was no difference in HR. Conclusion CVVHDF was effective, convenient and safe for patients with severely acute renal failure following cardiac surgery.

关 键 词：连续性肾脏替代治疗 急性肾衰竭 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学] R692.5[医药卫生—临床医学]