连续性血液净化治疗伴随低血压的肾前性肾功能衰竭

Continuous Blood Purification Treatment for Hypotension Patients with Prerenal Acute Renal Failure

目的伴随低血压的肾前性肾功能衰竭的患者不能承受传统的间歇性血液透析,本文探讨使用连续性血液净化对伴随低血压的肾前性肾衰竭的安全性和疗效。方法伴随低血压的肾前性肾衰竭患者68例,以行CBP的患者作为治疗组(34例),同期未行CBP而仅行内科常规治疗的患者作为对照组(34例)。两组均动态观察患者治疗前及治疗后血肌酐(Scr)、尿素氮(BUN)、碳酸氢根(HCO3-)、血钾(K+)及酸碱平衡等生化指标血乳酸等的变化,并动态监测心率、中心静脉压、多巴胺用量,比较两组疗效及生存率。结果连续性血液净化治疗组存活23例(67.6%),对照组存活6例(17.6%),两组差异显著(P<0.05)。连续性血液净化治疗过程中血流动力学稳定,肾功能、生化指标、心率、中心静脉压等均较对照组得到很好控制。结论连续性血液净化治疗能有效纠正伴随低血压的肾前性肾衰竭患者的氮质血症和水钠潴留、电解质及酸碱平衡紊乱,明显提高了患者的存活率。

Objective To observe the therapeutic effects and safety of continuous blood purification（CBP） on the hypotension patients with prerenal acute renal failure（PARF）,because hypotension patients with PARF can＇t bear the traditional intermittent hemodialysis.Method 68 cases of hypotension patients with PARF were randomly divided into treatment group and control group.Patients in treatment group were given CBP and those in control group were given routine medical therapy only.The changes of serum creatinine（Scr）,blood urea nitrogen（BUN）,HCO3-,K＋,blood lactic acid and blance of acid-base were observed before and after the treatment.At the same time,the heart rate,central vein pressure（CVP）,dopamine dosage were monitored dynamically.The curative effects and survival rate of patients in two groups were compared.Results The survival rate of patients in the treatment group（23 cases,67.6%） were significantly higher than those in control group（6 cases,17.6%）（P0.05）.Hemodynamic was stable during CBP treatment.The renal function,biochemical indicators,heart rate and CVP had been well controlled.Conclusions CBP can improve the survival rate of the hypotension patients with PARF markedly and correct nitrogen qualitative hematic disease,water natrium stove leave,imbalance of fluid electrolytes and acid-base effectively,which increase the surrival rate of patrents significantly.