不同血液净化方式治疗心脏手术后急性肾衰竭的疗效比较研究

The curative effects of various blood purification therapy for acute renal failure after cardiac surgery

目的 探讨连续性血液净化 (CBP)、间歇性血液透析 (IHD)、腹膜透析 (PD)治疗心脏手术后急性肾功能衰竭 (ARF)的疗效及预后差别。方法 回顾性分析 1990年 12月～ 2 0 0 3年 12月我院心脏手术后发生ARF需要血液净化治疗的患者 14 8例 ,其中 4 3例给予CBP治疗 ,77例接受IHD治疗 ,2 8例接受PD治疗 ,对比分析各组患者的临床资料、疗效和预后。结果 CBP组 2 6例 ( 6 0 .5 % )死亡 ,17例 ( 39.5 % )存活 ,IHD组 5 0例 ( 6 4 .9% )死亡 ,2 7例 ( 35 .1% )存活 ,PD组 17例 ( 6 0 .7% )死亡 ,11例 ( 39.3% )存活 ,各组无差异 ,但CBP组病情明显重于IHD组和PD组 :患者年龄更大 ,平均动脉压低 ,APACHEⅡ积分高 ,衰竭器官数目多 ,需要机械通气和升压药物的患者数高于IHD组 (P <0 .0 1)及PD组 (P <0 .0 5 ) ,CBP组中存活者平均A PACHEⅡ积分与IHD组及PD组死亡者相似。结论 CBP治疗心脏手术后ARF的疗效优于IHD及PD 。

Objective To investigate the efficacy and prognosis of various blood purification(CVVH?IHD?PD)in acute renal failure patients following cardiac surgery. Methods One hundred and forty-eight patients with acute renal failure(ARF) after cardiac surgery who received renal surpport therapy between Dec 1990 and Dec 2003 were involved in this study.Of them,43 were treated with continuous veno-venous hemofiltration(CVVH)(CBP group),77 with intermiffent hemodialysis (IHD group) and 28 were treated with peritoneal dialysis (PD group).Results Seventeen(39.5%) patients in CBP group survived and 26(60.5%) patients died, while 27(35.1%) patients in IHD group survived and 50(64.9%) patients died, 11(39.3%) patients in PD group survived and 17(60.7%) patients died, no significant difference in survival rate was found among three groups(P=0.45). Patients in CBP group were more severe as manifested by a lower mean arterial pressure, higher APACHEⅡ score,more dysfunctioned organs and more frequent requirement of mechanical ventilation and vasopressor support as compared with patients in other groups(P<0.05). The average APACHEⅡ score of survival in CBP group is similar to the died in other groups.Conclusion Our data suggest that CBP therapy is an effective treatment for acute renal failure after cardiac surgery and can improve the prognosis.