连续性肾脏替代治疗与间歇性血液透析治疗多器官功能障碍综合征的疗效比较  

Comparison of the effects between continuous renal replacement therapy and intermittent hemodialysis on patients with multiple organs dysfunction syndrome

作　　者：许元文[1] 余学清[1] 梁艳冰[1] 陈娟[2] 毛海萍[1] 吴培根[1] 管向东[2] 沈清瑞[1] 朱兰英[1] 李幼姬[1] 

机构地区：[1]中山医科大学附属第一医院肾内科卫生部肾脏病临床研究重点实验室,广州510080 [2]中山医科大学附属第一医院外科ICU,广州510080

出　　处：《中华肾脏病杂志》2001年第5期290-293,共4页Chinese Journal of Nephrology

基　　金：广东省科学委员会攻关项目基金(9827804)

摘　　要：目的 比较连续性肾脏替代治疗（ＣＲＲＴ）与间歇性血液透析（ＩＨＤ）治疗伴急性肾功能衰竭（ＡＲＦ）的多器官功能障碍综合征（ＭＯＤＳ）患者的疗效。方法　４９例伴ＡＲＦ的ＭＯＤＳ患者，２３例接受ＣＲＲＴ，２６例接受每周３次或隔日１次的ＩＨＤ。所有患者血液净化治疗前及治疗后记录液体摄入量，每日晨检查血肌酥、尿素氮、血钾、血碳酸氢根浓度，动脉血ｐＨ值。结果　ＣＲＲＴ组和ＩＨＤ组每日液体摄入量分别为（５１２８±１０３）ｍｌ、（２２０７±９７）ｍｌ（Ｐ＜０．０５）。ＩＨＤ组２１例次出现透析相关低血压、１７例次透析间期发生容量依赖性心功能衰竭，高于ＣＲＲＴ组的３例次及２例次（Ｐ＜０．０５）。ＩＨＤ组每日晨血尿素氮、血肌酥、碳酸氢根、ｐＨ值组内比较差异有显著性意义（Ｐ＜０．０５），而ＣＲＲＴ组组内比较差异没有显著性意义（Ｐ＞０．０５）；ＩＨＤ组每日晨平均血肌酥、尿素氮高于ＣＲＲＴ组（Ｐ＜０．０５）；ＩＨＤ组和ＣＲＲＴ组存活率分别为６５．４％（１７／２６）、３４．８％（８／２３），但在ＡＰＡＣＨＥ Ⅱ评分２７以上、衰竭器官数在３个以上的患者中，ＣＲＲＴ组和ＩＨＤ组存活率分别为２６．７％、１４．３％（Ｐ＞０．０５）。结论ＣＲＲＴ控?Objective To compare the efficacies between intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) on patients of multiple organs dysfunction syndrome (MODS) with acute renal failure (ARF) . Methods Of 49 MODS cases with ARF, 26 received IHD and 23 underwent CRRT. In all patients, volumes of infused fluid were recorded. Blood urea nitrogen (BUN), serum creatinine (Scr), hydrocarbonic, serum potassium, and artery blood pH were detected in all patients every morning after hemopurification. Results The volumes of infused fluid were(5 128 ± 103)ml and (2207 ±97) ml in CRRT and IHD group respectively( P <0. 05) . In IHD group, 17 cases(65. 4%) had cardiac failure between two hemodialysis sessions, and 21 cases(80. 7%) had hypotension during hemodialysis; but in CRRT group there were only 2 and 3 cases, respectively. Mean levels of above BUN, Scr in IHD group were significantly higher than those in CRRT group (P <0. 05). Mean levels of daily morning BUN, Scr, hydrocarbonic and artery blood pH showed significant difference in IHD group, but no significant difference in CRRT group. The survival rates were 65.4% (17/26) and 34.8% (8/23) in IHD and CRRT group respectively, but there was no significant difference in the patients with critical illness between these two groups. Conclusions CRRT has benefits in improving fluid-balance, acid-base balance and azotemia beyond IHD.

关 键 词：多器官功能障碍综合征 肾功能衰竭 血液透析 连续性肾脏替代治疗 

分 类 号：R459.5[医药卫生—治疗学]