连续性血液净化治疗心脏术后急性肾功能衰竭的效果评价

Evaluation of the therapeutic effect of continuous blood purification for patients with acute renal failure after cardiac surgery

目的:观察连续性血液净化(CBP)在心脏术后急性肾功能衰竭(ARF)患者防治中的疗效,并探讨CBP治疗的时机。方法:将18例心脏术后ARF患者分为A组(n=8,符合SIRS诊断)及B组(n=10,符合MODS诊断),对全部患者治疗前和治疗24h后进行ATN-ISI评分、APACHE评分,同时记录氧合指数,平均动脉压(MAP),心率(HR),中心静脉压(CVP),pH值,血尿素氮(BUN)和血肌酐(Scr)等指标进行比较。结果:1B组的病死率明显高于A组(70.0%vs12.5%);2CBP治疗24h后,A组及B组的APACHE评分、氧合指数、BUN和Scr显著改善,仅A组的MAP,pH值显著改善;而两组病人ATN-ISI评分、CVP、HR在治疗前后无明显差异。结论:CBP能改善心脏术后重症ARF的病情,但必须强调尽早认识SIRS并行CBP治疗,从而减少并发症的发生,降低病死率。

Objective :To investigate the effect of continuous blood purification(CBP) for patients with acute renal failure(ARF)after cardiac surgery,and to evaluate the timing of CBP.Methods :18 patients with ARF after cardiac surgery were divided into two groups:group A(SIRS,8cases) and group B(10 cases). ATN-ISI scores,APACHE Ⅲ scores, oxygenic index,mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),PH, serum urea nitrogen(BUN)and serum creatinine(Scr) were analyzedbefore CBP and after 24 hour's CBP and compared in each group.Results :① The mortality in group B was significantly higher than that of group A(70.0%vs 12.5%).② After 24 hour's treatment of CBP, APACHE Ⅲ scores ,oxygenic index,BUN and Scr were significantly improved in two groups,only MAP and PH in group A was significantly improved,whereras ATN-ISI scores, CVP and HR were not significantly changed.Conclusion:CBP is an important treatment for patients with ARF after cardiac surgery.But the most important problem in this process is the early recognition of SIRS and beginning of the CBP so as to make the rates of complication and mortality.