持续静脉-静脉血液滤过治疗老年急性肾衰竭

Evaluation of continuous veno-venous hemofiltration therapy on acute renal failure in the elderly

目的探讨应用持续静脉-静脉血液滤过(CVVH)治疗老年急性肾衰竭的价值。方法对我院危重病监护病房2000年6月～2004年12月应用血液净化治疗的30例老年急性肾衰竭患者进行回顾性分析。30例患者分为两组,常规血液透析(HD)组(16例)和CVVH组(14例),观察两组患者治疗前后血肌酐、血尿素氮、血PH、血碳酸氢根、血钾的变化,治疗过程中血压、心律的改变,心功能不全发生率和液体输入量,患者的死亡率。结果与常规血液透析组比较,CVVH组患者血肌酐、血尿素氮很快下降,并能维持在相对较低的水平;电解质、碳酸氢根、血PH水平较稳定,波动小,未发生高血钾。低血压、心律失常和心功能不全发生率低,而每天进入体内的液体却多过常规血液透析组,P<0.05。两组患者的死亡率无显著差异(P>0.05),但CVVH组患者的APACHEII评分明显高于常规血液透析组,P<0.05。结论CVVH较好地维持老年急性肾衰竭患者内环境的稳定,减少低血压、心律失常和心功能不全发生率,并能改善患者的预后。

Objictive To discuss therapy value of continuous veno-venous hemofiltration(CVVH)onacute renal failure in the elderly. Methods A total of 30 cases in the elderly with acute renal failure in intensive care unit during June of 2000 to December of 2004 were studied retrospectively. Patients were divided into two groups, routine hemodialysis group(n=16) and CVVH group (n=14).Serum creatinine, blood urea nitrogen, hydrocarbonic, serum potassium, artery blood PH were detected in all patients every day. In all patients, volumes of infused fluid, blood pressure, rhythm of the heart ,cardiac failure, mortality rate were recorded. Results The decreasing of serum creatinine, blood urea nitrogen and increasing of hydrocarbonic, artery blood PH was significantly faster in CVVH group. The inner environment can be kept stabilized in CVVH group. The rate of hypotension?arrhythmia and cardiac failure in CVVH group was significantly lower than routine hemodialysis group (P<0.05). The volumes of infused fluid daily in CVVH group was significantly much more (P<0.05).There was no significant difference of mortality between the two groups (P>0.05), but the score of APACHE II in CVVH group was significantly higher than routine homodialysis group (P<0.05). Conclusion CVVH can keep inner environment stabilized,decrease the rate of hypotension?arrhythmia and cardiac failure in the elderly with acute renal failure, and improve their prognosis.