肝移植后肾功能衰竭者的连续血液净化治疗

Continuous blood purification for renal failure after liver transplantation

背景:连续性血液净化又称为肾脏替代疗法,是近年来血液净化治疗技术的一项重要发展,在临床上已成为救治急性肾功能衰竭、多脏器功能衰竭及各种急危重患者必不可少的治疗手段。目的:总结肝移植后合并肾功能衰竭患者应用连续性血液净化的治疗技术。方法:回顾性分析10例肝移植后合并急性肾功能衰竭的患者应用BM-25连续性血液净化机治疗的临床资料,治疗模式为连续静静脉血液滤过,置换液使用方式是前/后稀释法,采用普通肝素、低分子肝素或无肝素抗凝。治疗时间为5～30d。观察患者治疗前及治疗24h后心率、平均动脉压、中心静脉压、尿素氮、血肌酐、血清钾、动脉血气碱剩余。结果与结论:10例患者中,好转8例,ICU存活率80.0%。连续性血液净化治疗过程中患者生命体征平稳、血流动力学指标好转,全身水肿逐渐减轻,呼吸状态好转。治疗24h心率显著下降,平均动脉压明显升高,中心静脉压显著下降。电解质、酸碱平衡维持正常,动脉血气明显改善,尿素氮、血肌酐、血钾明显降低。治疗前后两组数据比较,差异有显著性意义(P<0.05)。提示连续性血液净化治疗能明显改善肝移植后急性肾功能衰竭患者的预后,因而在肝移植后并发急性肾功能衰竭患者中得以广泛应用。

BACKGROUND：Continuous blood purification, also known as renal replacement therapy, is an important technique in recent years. It has been an essential way for treatment of acute renal failure, multiple organ failure and various acute and critical patients. OBJECTIVE：To evaluate the effect of continuous blood purification （CBP） on acute renal failure after liver transplantation. METHODS：We retrospectively analyzed the data of 10 patients complicated with acute renal failure after liver transplantation received CBP therapy using BM-25 CBP machine. Treatment pattern adopted continuous veno-venous hemofiltration （CVVH） and anterior/posterior dilution method. Ordinary heparin or low molecular heparin or non heparin was used as anticoagulant. Treatment time was 5-30 days. Heart rate （HR）, mean arterial pressure （MAP）, central venous pressure （CVP）, blood urea nitrogen （BUN）, serum creatinine （SCr）, potassium chloride （K＋）, and base excess （BE） were observed. RESULTS AND CONCLUSION： In the ten cases, eight cases survived, and the survival rate from ICU was 80.0%. During CBP treatment, vital signs were stable, hemodynamic markers improved, and anasarca gradually relieved. Twenty-four hours after CBP, HR and CVP decreased obviously as MAP increased. Electrolyte and blood gas analysis ameliorated obviously. BUN, SCr, and K＋ decreased. There was significant difference between the data before and after treatment （P 0.05）. It is indicated that CBP can obviously improve the prognosis of patients with acute renal failure after liver transplantation.