连续血液净化在肝移植术后合并感染性休克及肾功能衰竭中的应用

Application of Continuous Blood Purification in Acute Renal Failure and Infectious Shock after Liver Transplantation

【目的】探讨肝移植术后出现急性肾功能衰竭及感染性休克时,采用连续血液净化(CBP)治疗的方法和疗效。【方法】应用BM-25连续血液净化机治疗肝移植术后2例感染性休克合并急性肾功能衰竭病人,治疗模式为连续静静脉血液滤过(CVVH),置换液使用方式是前稀释法,采用普通肝素或低分子肝素抗凝,治疗时间共35 d。【结果】全部病例CBP治疗期间生命体征平稳,血流动力学指标好转,全身水肿逐渐减轻,呼吸状态好转。治疗后,电解质及动脉血气明显改善,尿素氮、肌酐、血钾明显降低。2例病人分别于治疗后28 h、75 h停用升压药。2例病人均存活。【结论】CBP为肝移植术后合并急性肾功能衰竭及感染性休克病人提供了良好的肾脏替代方式,可以改善病人的预后。

[Objective]To evaluate the effect of continuous blood purification（CBP）on acute renal failure and infectious shock after liver transplantation and its technique. [Methods] Two cases complicated with acute renal failure and infectious shock after liver transplantation received CBP therapy with BM-25 CBP machine. Treatment pattern adopted continuous veno-venous hemofihration （CVVH） and anterior dilution method. Or-dinary heparin or low molecular heparin was used as anticoagulant. [Results] During CBP, vital signs were stable, hemodynamie markers improved, and anasarea gradually relieved. Electrolyte and blood gas analysis a meliorated obviously after CBP 24h. Serum urea nitrogen, ereatinine and kalium decreased. Two cases didn＇t take medicine to maintain blood pressure after CBP 28h and 75h respectively. The two cases all survived. [Conclusion] CBP is an important method of renal replacement for patients complicated with acute renal failure and infectious shock after liver transplantation. It can improve patients′ prognosis.