不同急性肾损伤时期行CVVH治疗对心脏术后患者多脏器功能的影响  

Influence of continuous venovenous hemofiltration in different stages on important organs after cardiac surgery

作　　者：王萍[1] 蒋立虹[1] 邹弘麟[1] 韦杰[1] 欧阳晶[1] 

机构地区：[1]昆明医科大学附属延安医院,昆明650051

出　　处：《山东医药》2012年第45期14-16,共3页Shandong Medical Journal

基　　金：云南省科技计划资助项目(2008ZC149M)

摘　　要：目的探讨不同急性肾损伤(AKI)时期行持续性静—静脉血液滤过(CVVH)治疗对心脏术后患者多脏器功能的影响。方法对60例行心脏体外循环术后出现AKI患者的临床资料进行回顾性分析,将患者随机分为3组,其中对速尿治疗敏感、未行CVVH治疗32例(对照组),对速尿治疗不敏感、行CVVH治疗28例[Ⅰ期12例(H1组),Ⅱ期16例(H2组)。观察并比较各组心、肺、肝、肾功能的相关指标。结果三组比较,H2组血肌酐明显降低,H1组平均动脉压明显升高(P均<0.05);H1组、H2组中心静脉压、氧合指数、总胆红素、直接胆红素变化无统计学差异(P均>0.05)。对照组谷丙转氨酶升高,H1组、H2组升高后有下降趋势(P均<0.05)。结论不同AKI时期行CVVH治疗对心脏术后患者的多脏器功能影响各异,速尿治疗不敏感的Ⅰ期患者行CVVH治疗,有心、肾保护作用。Objective To research influence of continuous venovenous hemofiltration （CVVH） applied in different stages of acute kidney injury （AKI） on different important organs after cardiac surgery. Methods 60 patients, who under- went AKI after adult cardiac surgery by cardiopulmonary bypass, were retrospectively collected and were divided into 3 groups, including furosemide group of stage I of AKI （ control group, 32 patients）, CVVH group of stage I of AKI （ H1 group, 12 patients） and CVVH group of stage 1I of AKI （ H2 group, 16 patients）. Then their clinical data concerning im- portant organs such as heart, kidney, liver and lung were observed dynamically. Results Among three groups, consis- tence of creatinine from blood was going down more deeply in H2 group than H1 group （ P 〈 0.05 ）. Mean arterial pressure was most rising in HI group （P 〈 0.05）. Central venous pressure, oxygenation indexes, total bilirnbin, direct bilirubin were not significantly different in H1 group and H2 group （all P 〉0.05） . Glutamic-pyruvic transaminase （GPT） was ris- ing in control group, while rising and then going down in HI and H2 group （ all P 〈 0.05 ）. Conclusions CVVH initiated in different stages of AKI have different influences on different organs after cardiac surgery. In H1 group with diuretic drug resistance, functions of important organs including heart, kidney are protected better.

关 键 词：急性肾损伤 持续性静—静脉血液滤过 心脏手术 

分 类 号：R605[医药卫生—外科学]