持续血液净化治疗危重患者急性肾功能衰竭的临床观察

Clinical Observation on Critical Patients with Acute Renal Failure Treated by Continuous Blood Purification

【目的】探讨应用持续血液净化治疗危重患者急性肾功能衰竭(ARF)的价值。【方法】对本院应用血液净化治疗的148例危重患者ARF进行回顾性分析。148例患者分为:A组(常规血透组,86例)和B组(持续血液净化组,62例),观察比较两组患者治疗前后各项指标的变化及患者的病死率。【结果】与A组比较,B组患者血肌酐、血尿素氮较快下降,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透组(P<0.05)。B组血小板降低和APTT延长的发生率高于A组。两组患者的病死率无显著差异(P>0.05),但B组患者的APACHEⅡ评分明显高于A组(P<0.05)。【结论】持续血液净化能较好地维持危重ARF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。

[Objective]To explore the value of continuous blood purification for the treatment of critical patients with acute renal failure （ARF）. [Methods] Clinical data of 148 critical patients with ARF treated by blood purification in our hospital were analyzed retrospectively. A total of 148 patients were divided into gener al hemodialysis group （group A, n =86） and continuous blood purification group （group B, n 62）. In addi tion, Scr, BUN, PH, HCO3^- and K^＋ in blood, blood pressure, heart rate, incidence of heart failure, liquid circulation, coagulation function and mortality during treatment were compared and analyzed statistically. [Resuits]The decreasing value for Scr and BUN was greater and correspondingly steady. The electrolyte, PH and HCO3^- were steady. The incidence of hypotension, arrhythmia and heart failure was fewer, but the liquid circulation was quicker and the APACHE Ⅱ score was higher in group B than those in group A. All aforementioned comparisons had significant differences （ P 〈0.05）, but there were not significant differences for the decreasing of platelet and prolonging of APTT （ P 〉0.05）. [Conclusion] The continuous blood purification can better keep internal environmental steady, and decrease the occurrence for low blood pressure, arrhythmia and heart failure, and improve the prognosis in critical patients with ARF.