日间连续性静脉-静脉血液透析滤过治疗心脏术后肾功能不全  

Daytime continuous veno-venous hemodiafiltration in the treatment of renal failure following cardiac surgery

作　　者：喻磊[1] 潘晓雪[2] 谷天祥[1] 师恩祎[1] 范秋灵[3] 王波[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,沈阳110001 [2]中国医科大学附属第一医院血液净化中心,沈阳110001 [3]中国医科大学附属第一医院肾脏内科,沈阳110001

出　　处：《中国血液净化》2008年第7期354-356,共3页Chinese Journal of Blood Purification

摘　　要：目的总结日间连续性静脉-静脉血液透析滤过(CVVHDF)在心脏术后的临床应用经验。方法2002年6月～2008年3月对中国医科大学附属第一医院收治的12例患者在心脏手术后肾功能不全进行了日间CVVHDF,观察日间CVVHDF对患者的心率、中心静脉压、平均动脉压、动脉血氧分压、肾功能变化、升压药物剂量以及围术期和预后情况。结果12例患者中8例在体外循环下行冠状动脉旁路移植手术(CABG),2例在非体外循环下行CABG,2例在体外循环下行瓣膜置换手术,术后均进行日间CVVHDF,每次透析持续8～12h,第一次透析6h后患者的心率、中心静脉压、肌酐和尿素氮及多巴胺用量较未透析时明显下降(P<0.05),而平均动脉压、动脉血氧分压较未透析时明显升高(P<0.05)。围术期死亡2例,其余10例患者中有3例改为内科规律透析治疗,7例患者肾功能恢复到术前水平出院后尿量恢复未再透析治疗,术后随访(36.90±29.06)个月,生活质量明显提高。结论日间CVVHDF是治疗心脏术后肾功能不全的有效方法。Objective To summarize the experiences about daytime continuous veno-venous hemodiafiltration （CVVHDF） as a post-operational treatment for renal dysfunction following cardiac surgery, Methods During the period from Feb, 2002 to Mar. 2008, a total of 12 patients with renal dysfunction following cardiac surgery underwent daytime CVVHDE We observed their changes in heart rate （HR）, central vein pressure （CVP）, mean artery blood pressure （MAP）, PaO2, renal function, pressor medication used, perioperative manifestations and prognosis after the treatment. Results In the 12 patients, 8 cases underwent on-pump coronary artery bypass grafting （CABG）, 2 cases received off-pump CABG, and 2 cases underwent on-pump valve replacement. Daytime CVVHDF was performed for the 12 patients, and the dialysis lasted for 8-12 hours. After the first dialysis for 6 hours, HR, CVP, creatinine, BUN and dopamine used decreased significantly （P〈0.05, as compared with those before dialysis）, and MAP and PaO2 increased （P〈0.05, as compared with those before dialysis）. Two cases died in the perioperative period, 7 patients discharged from the hospital with renal function and urine volume recovering to the preopeartive levels and without the dialysis anymore, and the other 3 patients still needed regular dialysis treatment, The mean follow-up period was （36.90±29.06） months, and their life quality improved remarkably, Conclusion Daytime CVVHDF is an effective measure in the treatment of renal dysfunction following cardiac surgery.

关 键 词：连续性静脉-静脉血液透析滤过 冠状动脉旁路移植术 肾功能不全 

分 类 号：R459.5[医药卫生—治疗学]