连续肾脏替代疗法治疗急性肾功能衰竭伴多脏器衰竭  

Continuous renal replacement therapy in acute renal failure with multiple organ failure

作　　者：丁小强[1] 叶志斌[1] 蔡金根 廖履坦[1] 徐元钊[1] 吴兆龙[1] 陶凤武[1] 

机构地区：[1]上海医科大学中山医院肾内科,200032

出　　处：《中华肾脏病杂志》1998年第5期307-310,共4页Chinese Journal of Nephrology

摘　　要：目的观察连续性肾脏替代疗法(CRRT)治疗急肾衰(ARF)伴多脏器衰竭(MOF)的疗效,比较不同CRRT技术的优缺点及临床应用注意事项。方法 23例ARF伴MOF患者连续动静脉血液滤过(CAVH)11例,连续静静脉血液滤过透析(CVVH)(D)7例,日间连续性血液滤过透析(日间HDF)5例。结果均能满意控制水、钾和酸碱平衡,严重高分解代谢患者需同时透析。与血管通路有关及出血并发症仅见于CAVH组,而日间HDF组可出现低血压。死亡原因中,感染性休克最常见,占35.7%,急性呼吸窘迫综合征(ARDS)和胃肠道大出血各占21.4%。3例患者死于肾功能恢复期。结论 CRRT是治疗ARF伴MOF的有效方法,且患者耐受性较好,为原发病治疗和静脉营养的实施创造条件,可望改善预后。Objective To observe the efficacy and safety of continuous renal replacement therapy(CRRT) in acute renal failure (ARF)patients with multiple organ failure(MOF), and to discusse different modes of CRRT for the special indications. Methods 23 ARF patients with MOF were evaluated. The patients received unrandomly 3 modes of CRRT, including 11 patients with continuous arterial-venous hemofiltration(CAVH), 7 patients with CVVH(D)and 5 patients with day time continuous HDF. Results Water, potassium and acid-base balance were maintained effectively in all patients. Diffusion dialysis was necessary in patients with severe hypercatobolism state. Complications related to access and bleeding were observed mainly in CAVH patients, and hypotension in 2 patients with day time HDF. Septic shock remained the majo death cause and ARDS, gastroenteric bleeding were also the common death causes. Three patients died in renal function recovery period. Conclusion CRRT is effective for ARF with MOF with excellent hemodynamic stability, and makes it possible for the treatment of underlying disease and total paraenterol nutrition therapy therefore improves the prognosis.

关 键 词：肾脏替代疗法 血液透析 肾功能衰竭 多脏器衰竭 

分 类 号：R692.505[医药卫生—泌尿科学] R590.5[医药卫生—外科学]