论文部分内容阅读
目的观察连续性血液净化(CBP)在心脏术后急性肾功能衰竭(ARF)患者防治中的疗效,并探讨 CBP 治疗的时机及其与预后的关系。方法 26例心脏术后重症 ARF 患者按治疗时机分为 A(17例)、B(9例)两组。A 组当出现尿量连续8h<100 ml 且对60 mg 速尿无反应而不论肌酐水平多少时行 CBP;B 组当血肌酐>176.8μmoL/L 而不论尿量多少时行 CBP 治疗。对两组患者治疗前和治疗24 h 后的 MODS 评分、APACHEⅢ评分、平均动脉压(MAP)、氧合指数、血尿素氮(BUN)和血肌酐(Scr),以及手术距 CBP 时间、CBP 持续时间和术后并发症等指标进行比较。结果①B组手术距 CBP 时间明显长于 A 组,A 组术后心衰、肺水肿、ARDS、脓毒血症、器官衰竭数目明显少于 B 组(P<0.05)。②B组的死亡率明显高于 A 组(77.8%vs 29.4%,P=0.038);③CBP 治疗24 h 后,A 组及 B 组的 APACHEⅢ评分、氧合指数、BUN 和 Scr 均有明显改善,仅 A 组的 MODS 评分、MAP 显著改善(P<0.05)。结论 CBP 是防治心脏术后重症 ARF 的有效手段,但必须强调合适的治疗时机,其治疗时机应选择发生少尿或无尿的期间,而不应以肌酐水平作为标准,从而及早行 CBP 治疗,减少并发症,提高生存率。
Objective To observe the efficacy of continuous blood purification (CBP) in the prevention and treatment of acute renal failure (ARF) after cardiac surgery and to explore the timing of CBP treatment and its relationship with prognosis. Methods Twenty-six patients with severe ARF after cardiac surgery were divided into two groups according to the timing of treatment: A (17 cases) and B (9 cases). Group A received CBP when there was a continuous urine output of <100 ml for 8 h and no reaction to 60 mg of furosemide regardless of creatinine level. Group B received serum CBP> 176.8 μmol / L regardless of urine volume. The MODS, APACHEⅢ, MAP, oxygenation index, blood urea nitrogen (BUN) and serum creatinine (Scr) were measured before and 24 h after treatment, and CBP duration Time and postoperative complications and other indicators were compared. Results ① The distance from CBP in group B was significantly longer than that in group A. The number of postoperative heart failure, pulmonary edema, ARDS, sepsis and organ failure in group A was significantly less than that in group B (P <0.05). ② The mortality of group B was significantly higher than that of group A (77.8% vs 29.4%, P = 0.038). ③ After 24 h, the APACHEⅢ score, oxygenation index, BUN and Scr in group A and B were significantly improved The MODS score and MAP of group A were significantly improved (P <0.05). Conclusion CBP is an effective means of prevention and treatment of severe ARF after cardiac surgery. However, it is necessary to emphasize the appropriate timing of treatment and the timing of its treatment should be in the period of oliguria or anuria. Instead of creatinine level, CBP should be treated as early as possible. Reduce complications and improve survival.