连续性血液透析滤过对急性肾功能衰竭患者重要脏器功能和预后的影响  

Effect of Continuous Venous-venous Hemodiafiltration on Major Organ Function and Prognosis in Acute Renal Failure

作　　者：严玉澄[1] 钱家麒[1] 朱铭力[1] 曹励鸥[1] 徐筱琪[1] 

机构地区：[1]上海第二医科大学附属仁济医院肾内科,200001

出　　处：《诊断学理论与实践》2003年第4期293-295,302,共4页Journal of Diagnostics Concepts & Practice

摘　　要：目的:了解连续性血液透析滤过(CVVHDF)治疗对于重症急性肾功能衰竭(ARF)患者重要脏器功能和预后的影响。方法:观察进行CVVHDF的严重ARF患者的临床和实验室检查,应用APACHEⅡ评分系统对治疗前后患者的疾病严重性和各脏器功能的损害进行评估。结果:ARF患者共18例,均同时伴有全身其他脏器的功能损害,CVVHDF平均透析时间为(17.6±9.2)h,透析前平均APACHEⅡ评分为25±7,平均预计病死率为52.7%,透析前后患者的血压可保持平稳,血清总胆红素(SB)和丙氨酸转氨酶(ALT)无明显差异,血肌酐(SCr)从(737.9±361.1)μmol/L降至(432.9±178.0)μmol/L,血尿素氮(BUN)从(34.1±14.8)mol/L降至(21.7±10.4)mmol/L(P均<0.05),动脉血pH、Na+、HCO3-透析前后无明显变化,血钾由(4.6±0.9)mmol/L降至(3.7±0.6)mmol/L(P<0.05),Glasgow昏迷评分无变化。透后APACHEⅡ评分平均为25±6,平均病死率为54.3%,与透析前相比没有显著差别。本组研究的实际病死率为55.6%,与APACHEⅡ评分系统估计的病死率相似,APACHEⅡ评分死亡的患者(30±5)与存活的患者(19±3)相比较高(P<0.001)。结论:CVVHDF有利于改善重症ARF患者的肾功能,纠正电解质的紊乱,对心、肝、脑等重要脏器无不良反应,重症ARF患者的病死率取决于治疗开始时的疾病严重性,APACHEⅡ评?Object ive:To investigate the effect of continuous venous-venous hemodiafiltration(CVV HDF)on major organ func-tions and prognosis in patients with severe acute renal failure.Methods:The clinical and laboratory data of severe acute renal failure patients receiving CVVHDF were observed and analyzed,and the effect of CVVHDF on the function of major organs and the severity of disease were assessed accordin g to APACHEⅡScoring System.Results:There were18acute renal failure patients and all of the accompanied with other major organ injuries.The average duration of CVVHDF was(17.6±9.2)hours.APACHEⅡscore was25±7before dialysis and the predi ctive mortality was52.7%.There was no dif-ference in blood pressure,ALT and SB before and after CVVHDF,while serum creatinine[Cr(737.9±361.1)ìmol/L vs(432 .9ìmol/L,P<0.05]and nitrogen[BUN(34.1 vs(21.7 mol/L,P<0.05]was significantly decreased.There were no obvious changes of pH,Na + ,HCO 3 before and after dialysis,and hyperkalemia could be cor-rected[(4.6 mmol/L vs(3.7 significant changes of Glasgow's coma s core were found af-ter therapy.APACHEⅡwas25±6and mean mortality was54.3%after CVVHDF,which is similar to those before dialy-sis.The actual mortality of the group was55.6%,which was similar to that predicted by APACHEⅡ.APACHEⅡscore was higher in the died patients compared to those of the survived[(30±5)vs(19± 3),P<0.001].Conclusion:CVVHDF can improve renal function in patient with sever e acute renal failure and correct the electrolyte disorders.It has no side effec ts on the major organs.The mortality of patients may be determined by the diseas e severity before the start of therapy.APACHEⅡscore is effective in predicting the prognosis of the patients.

关 键 词：连续性血液透析滤过 急性肾功能衰竭 预后 病理生理学 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]