连续性静脉-静脉血液滤过在主动脉夹层术后急性肾衰竭中的应用

Application of continuous veno-venous hemodiafiltration to acute renal failure after aortic dissection surgery

目的 探讨连续性静脉-静脉血液滤过（CVVH）在主动脉夹层术后急性肾衰竭（ARF）中应用的临床意义.方法 15例术后ARF患者,采用CVVH治疗,比较治疗前后血电解质、尿素氮、肌酐等相关指标的变化,以及全身水肿情况.结果 11例存活,4例死亡.存活患者血液滤过后尿素氮[（37.2±12.1）mmol/L与（22.1±6.8）mmol/L]和血肌酐[（351.4±160.9）μmol/L与（185.7±97.6）μmol/L]均逐渐下降直至恢复正常,尿量分别于滤过后6～40 d恢复正常,肾功能恢复时间为8～60 d.所有患者血液滤过后水肿得到明显改善.结论 CVVH是治疗主动脉夹层术后ARF的一种有效、方便而安全的方法.

Objective To study the curative effect of continuous veno-venous hemodiafiltration（CVVH）in patients with acute renal failure（ARF）after aortic dissection surgery. Methods Fifteen patients with renal dysfunction following aortic dissection surgery underwent CVVH from Feb. 2002 to Dec. 2009 in this study.The clinical data of these patients were collected,such as heart rate（HR）,central vein pressure（CVP）,mean artery blood pressure（MAP）,PaO2,renal function,perioperative manifestations and outcomes. Results Eleven patients survived but 4 died during the course of treatment. There were significant decreases of BUN,Creatinin after CVVH （P 〈 0. 05）treatment,and the urine volume returned to nomal after CVVH in 6 -40 days. Conclusions CVVH is an effective,convenient and safe treatment for patients with severely ARF following aortic dissection surgery.