床边间歇性血液透析治疗危重症患者的疗效分析  

Clinical efficacy of bedside intermittent hemodialysis in critically ill patients

作　　者：张莹[1] 古英明[1] 黄莹[1] 肖龙[1] 蔡扬[1] 吕少芬[1] 陈星[1] 陈华玲[1] 

机构地区：[1]广州医学院第二附属医院血液净化科,广州510260

出　　处：《临床肾脏病杂志》2011年第7期327-329,共3页Journal Of Clinical Nephrology

摘　　要：目的探讨我院自行研发的床边透析技术为不能移动的合并肾衰竭的危重症患者进行有效肾脏替代治疗的效果。方法回顾性分析我院重症监护病房（ICU）行床边间歇性血液透析（IHD）患者121例，分别统计治疗前、后急性生理学和慢性健康状况评分Ⅱ（APACHEⅡ）、Boston心力衰竭积分、心率、平均动脉压（MAP）、血肌酐（SCr）、二氧化碳结合力（C02CP）、pH值，并对死亡组与生存组行统计学分析。结果IHD治疗后APACHEⅡ积分、Boston积分、心率、SCr、CO2CP、pH值明显改善（P〈0．05）。治疗后死亡61例，生存60例；其中急性肾衰竭患者78例。生存组患者年龄小于死亡组。合并机械通气、病因为脑损伤的差异均有统计学意义（P〈0．05）。结论我院床边IHD利于危重症患者病情好转；当患者血流动力学较稳定时，床边IHD是优先选择的治疗方法；只要使用合适的透析设备和合理的治疗方案，IHD仍是治疗合并急、慢性肾衰竭危重症患者的良好选择。Objective To investigate the effect of bedside renal replacement therapy which was developed by our hospital for unmovable critically ill patients with renal failure. Methods One hundred and twenty- one patients treated by bedside intermittent hemodialysis （IHD） in intensive care unit between May 2005 and May 2010 were studied. Acute physiology and chronic health evaluation （A- PACHE Ⅱ） score, score of Boston criteria for diagnosing heart failure, heart rate, mean arterial pressure, serum creatinine （Scr）, carbon dioxide combining power（CO2 CP） and pH were recorded. Statistical analysis was made between death group and survival group. Results APACHE Ⅱ score, score of Boston criteria,heart rate, SCr, CO2 CP and pH were improved after treatment of bedside IHD（P〈 0. 05）. Sixty patients survived,61 patients died,and 78 patients had acute renal failure. There was significant difference in age, mechanical ventilation and brain damage（P〈0. 05） between two groups. Conclusion Bedside IHD in our hospital is beneficial to critically ill patients. Once hemodynamic stability is attained, IHD should be the preferred modality. If the equipment for dialysis is appropriate and therapeutic plan is rational, IHD will be a good choice for critically ill patients with acute renal failure or chronic renal failure.

关 键 词：肾透析 危重症 肾衰竭 

分 类 号：R692.5[医药卫生—泌尿科学]