连续性血液净化在老年感染性休克致急性肾衰竭中的应用

Application of continuous blood purification in elderly patients with acute renal failure induced by septic shock

目的探讨连续性血液净化(CBP)在老年感染性休克致急性肾衰竭中应用效果。方法 87例患者给予对症治疗原发病,积极控制感染,积极抗休克治疗,快速纠正水电解质酸碱平衡,加强营养支持治疗,在上述基础上,所有患者均给予CBP治疗,其中A组超滤率为20 ml/(kg.h),B组为35 ml/(kg.h),C组为45 ml/(kg.h),观察CBP治疗前后A、B、C组患者24h测定血尿素氮(BUN)、肌酐(Cr)、二氧化碳结合力(CO2CP)、血钾(K+)、C-反应蛋白(CRP)等变化及存活率;每30min记录1次血压、心率、呼吸、血氧饱和度及体温、尿量等。结果经连续血液透析及综合治疗24～48h,55例患者自觉症状缓解,血压平稳,无明显浮肿,心力衰竭、肺水肿、电解质和酸碱平衡紊乱、高钾血症等并发症得到纠正;BUN、Scr CRP均低于治疗前,CO2CP趋于正常,氧合指数得到明显改善,平均动脉压均缓慢回升;22例患者死于多器官功能障碍综合征,死亡率为25.3%。结论 CBP能改善老年感染性休克所致急性肾功能衰竭(ARF)的病情,强调尽早行CBP治疗以及熟练、专业化的护理技术操作,从而减少并发症的发生,降低病死率。

OBJECTIVE To investigate the application effect of continuous blood purification（CBP） in elderly patients with acute renal failure（ARF） induced by septic shock.METHODS Eighty seven patients were given symptomatic treatment for primary disease with positive infection control,active anti-shock treatment,correction of water and electrolyte acid-base balance,and nutrition support therapy.Besides,all patients were treated with CBP.The ultrafiltration rate in group A was 20ml/（kg·h）,group B 35ml/（kg·h）,and group C 45ml/（kg·h）.The changes and survival rate of 24h blood urea nitrogen（BUN）,serum creatinine（Scr）,carbon dioxide combining power（CO2CP）,potassium（K＋）,C-reactive protein（CRP） before and after CBP treatment for A,B,C group were observed.Blood pressure,heart rate,respiration,oxygen saturation and body temperature,urine output and so on were recorded every 30 minutes.RESULTS After continuous hemodialysis and the combined treatment for 24 to 28 hours,the symptom was alleviated in 55 patients with stable blood pressure and no apparent swelling.Complications such as heart failure,pulmonary edema,electrolyte and acid-base balance disorders,and hyperkalemia were basically improved.BUN and Scr CRP were lower than that before treatment,and CO2CP was normal.There was significant improvement in oxygenation index,and the arterial pressure was slowly picking up.Twenty two patients died of multiple organ dysfunction syndrome,and the mortality rate was 25.3%.CONCLUSION CBP can improve the condition of elderly patients with ARF induced by septic shock.CBP treatment should be adopted as early as possible,and skilled,professional care and technical operations should be taken to reduce the incidence of complications and the mortality.