连续性血液净化救治合并急性肾衰的老年多脏器功能衰竭

Effect of continuous blood purification on multiple organ failure in elderly patients complicated with acute renal failure

目的 探讨连续性血液净化 (CBP)在合并急性肾衰的老年多脏器功能衰竭 (MOFE)救治中的应用及其对预后的影响。方法 2 0 0 1年 11月至 2 0 0 3年 8月应用CBP治疗合并急性肾功能衰竭的MOFE 5 1例 ,采用德国FreseniusADM0 8TM/ABMTM肾脏替代治疗床边机 ,4 1例行连续性静脉至静脉血液滤过 (CVVH) ,10例行连续性动脉至静脉血液滤过 (CAVH) ,每次治疗时间 8～ 4 9小时 ,39例高分解代谢者 ,再转换连续性静脉至静脉血液透析(CVVHD)或连续性动脉至静脉血液透析 (CAVHD) 2～ 4小时 ,12例予连续性高容量血液滤过 (CHVHF)。结果 37例 (72 .5 % )死亡 ,14例 (2 7.5 % )摆脱MOFE而存活 ;死亡组患者在停止CBP时平均尿素氮 (BUN)、血肌酐 (SCr)、中心静脉压 (CVP)、平均动脉压 (MAP)、动脉氧分压 (PaO2 )均较CBP前显著改善 (P <0 .0 1) ;衰竭代偿期患者病死率(4 /10 )与衰竭失代偿期患者病死率 (33/41)比较 ,差异有统计学意义 (P <0 .0 5 ) ;采用CHVHF患者存活率显著高于非CHVHF患者 (P <0 .0 0 1)。结论 CBP是治疗合并肾功能衰竭的MOFE的有效手段 ,能降低病死率 ,改善预后 ;CBP开始治疗越早 ,效果越好 ;

Objective To evaluate the effect of continuous blood purification(CBP) in the multiple organ failure in the elderly(MOFE) patients complicated with acute renal failure(ARF).Methods To investigate the experience with 51 MOFE patients complicated with ARF treated with CBP from November 2001 to August 2003.All the patients were treated for 8 to 49 hours with ADM08 TM/ABM TM(Freesias Co,German): 41 treated by continuous venovenous hemofiltration (CVVH),10 with continuous arteriovenous hemofiltration (CAVH),and 39 hypercapabolic patients,then turned to continuous venovenous hemodialysis(CVVHD) or continuous arteriovenous hemodialysis(CAVHD) for 2 to 4 hours after CVVH or CAVH,and 12 with continuous high volume hemofiltration (CHVHF).The patients′ age,sex,and characters of renal failure were recorded.Results Thirty-seven ( 72.5%) died,and fourteen( 27.5%) patients survived.In the death group,the patients′ levels of blood urea nitrogen,serum creatinine,central venous pressure,mean arterial pressure,and partial pressure of oxygen of arterial blood were significantly ameliorated than those before CBP.The mortality rate(4/10) in the renal failure compensation patients was significantly less than that (33/41) in the renal failure patients (P< 0.05).The survival rate in the CHVHF group is significantly higher than that in the non-CHVHF group (P< 0.001).Conclusion CBP is an effective method for MOFE with renal failure,can decrease the mortality rate,and ameliorate the prognoses.The earlier the CBP begins,the better the effect shows.CVVHF can raise the survival rate greatly.