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

TREATMENTOFSEVEREACUTERENALFAILUREWITHCONTINUOUSRENALREPLACEMENTTHERAPYVERSUSINTERMITTENTHEMODIALYSIS

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１０１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６０例（５９４％）存活，４１例（４０６％）死亡，ＩＨＤ组５９例（６４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０５），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，能改善重症ＡＲＦ的预后。

OBJECTIVE Toinvestigatetheefficacyandprognosisofcontinuousrenalreplacementtherapy(CRRT)versusintermittenthemodialysis(IHD)insevereacuterenalfailure(ARF)patients. METHODOLOGY OnehundrendandnintythreesevereARFpatientswhoreceivedrenalsupportbetweenDec1978andDec1998wereinvolvedinthisstudy.Ofthem,101(523%)weretreatedwithCRRT(CRRTgroup)and92(477%)withIHD(IHDgroup). RESULTS Sixty(594%)patientsinCRRTgroupsurvivedtheacutephaseoftheillnessand41(406%)patientsdied,while59(641%)patientsinIHDgroupsurvivedand33(359%)patientsdied,nosignificantdifferenceinsurvivalwasfoundbetweenthetwogroups.AstothepatientswithMODS,24outof26patients(375%)withMODSinCRRTgroupsurvived,whileinIHDgroup8outof44(273%)survived,whichwasmuchhigherinCRRTgroup.PatientsinCRRTgroupweremoreseverelyillasmanifestedbyalowermeanarterialpressure,higherPAACHEscore,moredysfunctionedorgansandmorefrequentrequirementofm