持续肾脏替代治疗心源性休克并发急性肾功能衰竭  

Clinical application of continuous renal replacement therapy for cardiogenic shock with acute renal failure

作　　者：张代富[1] 于萍[1] 祁炜罡[1] 来晏[1] 张旭敏[1] 顾宇英[1] 朱琛颖[1] 

机构地区：[1]同济大学附属东方医院心内科,上海200120

出　　处：《临床心血管病杂志》2009年第3期197-199,共3页Journal of Clinical Cardiology

摘　　要：目的:总结10例心源性休克并发急性肾功能衰竭应用持续肾脏替代治疗的临床经验。方法:2004年10月至2008年2月,对10例急性心肌梗死合并心源性休克并发急性肾功能衰竭患者应用持续肾脏替代治疗,所有患者都有难以控制的心源性休克,7例患者予急诊冠状动脉介入治疗,其中6例患者开通梗死相关血管;9例患者予气管插管,呼吸机辅助呼吸;1例患者予无创呼吸机辅助;10例患者均予主动脉内气囊泵辅助;患者均行深静脉穿刺,前稀释连续性静脉-静脉血液滤过。结果:持续肾脏替代支持72～480h,平均216h。6例患者顺利脱离持续肾脏替代治疗,5例存活,1例死亡;4例患者心源性休克不能纠正死亡。5例存活病例随访1个月～3年,均存活。结论:持续肾脏替代治疗可对心源性休克并发急性肾功能衰竭提供有效支持治疗,延长这部分高危患者的生命。Objective：To summarize the clinial value of continuous renal replacement therapy （CRRT） for 10 cardiogenic shock patients with acute renal failure （ARF）. Method：From Oct. 2004 to Feb. 2008, the continuous renal replacement therapy was applied to 10 cardiogenic shock patients with acute renal failure, who were on admission diagnosed with acute myocardial infarction （AMI） and developed refractory cardiogenic shock. Mean duration of CRRT was 216 h （72-480 h）. The volume of unltrafiltration fluid was 80-200 ml/h and the velocity of blood flow was 120-200 ml/min. Continuous venovenous hemofilatration （CVVH） or continuous venovenous hemodiafilatration （CVVHDF） was used. Result：For the 10 patients, 6 were succesfully off the CRRT, 5 of which survived followed by 1 month to 3 years and 1 of which died of severe complication, another 4 failed. Conclusion： CRRT is an effective measure to the cardiogenic shock patients with ARF,which can improve the prognosis.

关 键 词：持续肾脏替代 心源性休克 心肌梗死 急性肾功能衰竭 

分 类 号：R542.2[医药卫生—心血管疾病]