连续性血液净化在心脏手术后急性少尿型肾衰中的应用

Continuous blood purification treatment of oliguric acute renal failure after heart surgery

目的探讨连续性血液净化(CBP)在治疗心脏手术后急性少尿型肾衰竭中的效果。方法将27例心脏手术后急性少尿型肾衰竭伴血流动力学不稳定、低血压休克患者分为存活组(A组,n=14)和死亡组(B组,n=13),比较CBP治疗前及治疗后12、24、48 h两组APACHEⅡ-评分、血气分析指标、平均动脉压、肾功能、血管活性药使用情况。结果(1)A组和B组CBP治疗后各项检测指标与治疗前比较均有一定差异,A组效果更佳。(2)CBP治疗后A组的平均动脉压及升压药用量变化与治疗前比较差异有统计学意义,B组则差异无统计学意义。(3)A、B组之间APACH-Ⅱ评分、器官衰竭数目及CBP治疗距急性肾衰竭(ARF)诊断的时间差异有统计学意义(均P<0.05)。结论CBP是治疗心脏术后急性少尿型肾衰的有效方法,它有助于维持患者的内环境、纠正血流动力学不稳定状态,ARF合并其他器官衰竭者早期行CBP治疗是降低死亡率的关键措施。

Objective To study the efficacy of continuous blood purification(CBP) treatment on oliguric acute renal failure(OARF) after heart surgery.Methods Twenty-seven patients were divided into two groups:group A(consisting of 14 surviving patients) and group B(consisting of 13 deceased patients),all of them had undergone an OARF after heart surgery and treated by CBP.We compared the differnce of APACHE-Ⅱ marks,blood gas indexes,mean artery pressure,renal function as well as usage of vasoactive drugs preceding to and 12,24,48h after heart surgery in these two groups.Results(1) After CBP treatment,analysis indexes of both groups had improved with group A improving more.(2) After CBP treatment,there was a significant improvement in group A in mean artery pressure and pressor dosage while no significant improvement was found in group B.(3) There was a significant difference between group A and group B in APACH-Ⅱ marks,organ failure and the time gap between ARF diagnosis and CBP treatment(P<0.05).Conclusions CBP is an effective means to treat OARF after heart surgery,by maintaining the patients′ internal condition and remedying hemodynamic instability.Early CBP treatment for ARF is a key method to reduce the mortality.