连续性肾脏替代治疗在MICU危重患者中的应用

The application of contitunous renal replacement therapy in severe patients in MICU

目的探讨连续性肾脏替代治疗(CRRT)在危重患者中的应用价值。方法选择内科重症监护室(MICU)实施CRRT治疗患者21例,均采用Prisma机器以及配套的管路和滤器,血管通路均采用股静脉或颈内静脉留置双腔导管,方式根据患者情况选择连续静脉血液滤过(CVVH)、连续静脉血液透析(CVVHD)、连续静脉血液透析滤过(CVVHDF),透析持续时间每日8～12小时,如病情需要则24小时持续进行,血流速100～150 ml/h,置换液30～50 L/次;每次脱水量根据病情设置1～3 kg。观察治疗前后临床症状,血流动力学,血生化,PaO2/FiO2,pH的变化及血培养结果。结果治疗后血培养转阴,血清尿素氮、肌酐值明显下降,氧合也有明显的改善。结论CRRT对于危重症患者来说是一个基本的治疗工具和重要的支持疗法。

Objective To investigate the practical value of continuous renal replacement therapy（CRRT） on the severe patients in MICU. Methods 21 cases who had applied to CRRT in MICU were selected. Double channel catheter was inserted in femoral vein or internal carotid vein,according to the pathogenetic condition. The patients were treated by Continuous Venovenous Hemofiltration （CVVH） Continuous Venoveneus Hemodialysis（CVVHD） and Continuous Venovenous Hemodiafihration （ CVVHDF）. The duration was 8 - 12 hours or continuation if necessary. The volume of blood flow was 100 - 150 ml/h, and the displacement liquid was 30 - 50 ml/time. The volume of dehydration was 1 - 3 kg according to the pathogenetic condition. The clinical symptoms, hemodynamics, blood biochemistry, PaO2/ FiO2,pH, and hemocuhure before and after therapy were observed. Results After the treatment, the hemocuhure became minus, the serum creatinine and blood urea nitrogen decreased apparently, and oxygenation improved apparently. Conclusion To severe patients, CRRT is a basic treatment and an important supportive therapy.