持续肾脏替代治疗在ICU中的应用

Application of continuance renal replacement therapy in ICU

目的 观察持续肾脏替代治疗 (CRRT)在ICU抢救危重病人的治疗效果与存活率的关系。方法 治疗 94例急、慢性肾衰及多脏器衰竭 (MOF)的病人 ,其中应用持续性动脉—静脉血液滤过 (CAVH) 2 8例和持续性静脉—静脉血液滤过(CVVH) ) 6 6例。结果 ①将患者年龄分为 4组 ,即 <30岁、30～ 5 0岁、5 0～ 70岁、>70岁年龄组 ,随年龄增高存活率逐渐下降 ,具有显著性差异P <0 0 0 1。② 1个脏器衰竭有 2 7例 ,存活率 6 7% ;2个脏器衰竭 ,有 33例 ,存活率 10 % ;3个脏器衰竭有 34例 ,存活率 9% ;三者具有显著性差异 ,P <0 0 0 1。③对CAVH组 2 8例及CVVH组 6 6例的存活率进行统计分析 ,两组无显著性差异。④患者经过平均连续 7d的血滤 ,治疗前后血BUN及血Cr均有明显的下降 ,具有显著性差异 ,P <0 0 1;而存活组与死亡组溶质的清除率无显著性差异 ,P >0 0 5。结论 CRRT是抢救危重病人的有效手段之一 ,不受年龄的限制 ,患者耐受性较好 ,能有效地清除小分子物质 ,病人的存活率与年龄和病人的器官衰竭数目有关 ,年龄越大 ,脏器衰竭数目越多 ,其死亡率越高。

Objective To evaluate of the continuous renal replacement therapy(CRRT) results and the relation of survival rate of critical patient in ICU.Methods To treat 94 examples,acute,chronic kidney failure and MOF’s patient,use the CAVH 28 examples and CVVH 66 examples among them.Results ①Age patient divided into four groups,<30 years,30～50 years,50～70 years,>70 years age class,with increasing at the age survival rate drops gradually,there are significant difference P <0.001.②one organ failure have got 27 examples,survival rate 67%;two organs failure,have got 33 examples,survival rate 10%;three organs failure have got 34 examples, survival rate 9%;there are significant difference, P <0.001.③Carry on statistical analysis to 28 examples of CAVH group and 66 examples of CVVH survival rate,two groups do not have remarkable quality.④The patient through average in hemofiltration for 7 days,around treating blood BUN and blood Cr have obvious decline,there are remarkable qualities, P <0.01.The removing rate which store the alive group and group of the death solute does not have remarkable quality, P >0.05.Conclusion CRRT rescue the effective means of the critical patient,not receive restriction of age,the patient is able to bear at the quality better,can remove the little member material effectively,the survival rate of patient has something to do with age and patient’s organ failure,the older the age,the more failures of internal organs,the higher its death rate. [