连续性肾脏替代治疗与间歇性血液透析治疗重症急性肾衰的比较研究(英文)

A retrospective study of continuous renal replacement therapy versus intermittent hemodialysis in severe acute renal failure

目的 回顾性研究连续性肾脏替代治疗 (CRRT)与间歇性血液透析 (IHD)治疗重症急性肾衰的疗效及影响预后的因素。方法 收集 1978年 12月 - 1998年 12月住院的重症ARF患者 193例 ,其中 10 1例行CRRT (CRRT组 ) ,92例行IHD (IHD组 ) ,回顾性对比分析两组患者的临床资料、疗效和预后。结果 CRRT组 6 0例 (5 9 4 % )存活 ,4 1例 (40 6 % )死亡 ,IHD组 5 9例 (6 4 1% )存活 ,33例 (35 9% )死亡 ,两组无差异 ,但CRRT组病情明显重于IHD组 :患者年龄更大 ,平均动脉压低 ,APACHEⅡ积分高 ,衰竭器官数目多 ,需要机械通气和升压药物的患者数高于IHD组 (P <0 0 5 ) ,CRRT组中存活者平均APACHEⅡ积分与IHD组死亡者相似。CRRT组血流动力学稳定 ,容量状态精确平衡 ,氮质血症控制更佳 ,ARF持续时间缩短。结论 ①重症ARF的预后受年龄的影响 ,与原发病因和疾病严重程度有关 ;②CRRT治疗重症ARF的疗效优于IHD 。

Objective To investigate the efficacy of continuous renal replacement therapy(CRRT)versus intermittent hemodialysis(IHD)in patients with severe acute renal failure(ARF).Methods One hundred and ninety -three severe ARF patients who received renal support between December 1978 and December 1998 were involved in this study.Of them,101(52.3%)were treated with CRRT(CRRT group),and 92(47.7%)with IHD(IHD group).Results Sixty(59.4%)patients in the CRRT group got through the acute phase of disease and 41 (40.6%)patients did not survive while in the IHD group 59(64.1%)patients survived and 33(35.9%)patients did not.No significant difference in survival rate was found between the two groups.24 of 64 patients(37.5%)in the CRRT group with multiple organ dysfunction syndrome(MODS)survived,while in the IHD group,8 out of 44(27.3%)survived,their survival rate was much lower than that in the CRRT group.Patients in CRRT group were more severely iii,as manifested by lower mean arterial pressure,higher APACHE Ⅱ score,more dysfunctioned organs and requiring mechanical ventilation and vasopressor support as compared with patients in the IHD group,CRRT was found to improve hemodynamic stability with a better fluid balance and control of biochemical status,increased nutritional intake and a shorter duration of acute renal failure(P ＜ 0.05).Conclusion CRRT perhaps may be the best choice in the treatment of severe ARF patients,for it can offer several distinct advantages compared to IHD.These may contribute to improving the survival rate of ARF patients,particularly those that are critically ill patients.