摘要
目的探讨连续性肾脏替代治疗（CRRT）应用于急性肾功能衰竭（AnF）伴多器官功能障碍综合征（NODS）的临床疗效和对预后的影响。方法45例ARF伴MODS的患者应用CRRT，CRRT模式为连续静脉-静脉血液滤过。所有患者在CRRT的治疗前及治疗后第1、2,3、4天晨采周围静脉血查血肌酐（SCr）、尿素氮（BUN）、尿酸、血常规及c-反应蛋白（CRP）；同时测治疗前及治疗后6h血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-4、IL-6；定时监测血流动力学、血气分析及电解质。结果与治疗前相比，治疗后SCr、BUN、尿酸、CRP均显著下降（P〈0.05）；pH值能维持在7.30～7.40，血电解质由置换液调整基本正常；治疗前及治疗后6h血清TNF-α、IL-4、IL-6变化的差异均有统计学意义（P〈0.05）；存活26例患者，均为急性生理及慢性健康状况Ⅱ（APACHEⅡ）评分在25分以下、衰竭器官数小于3个、年龄较小、入ICU到开始CRRT时间短且CRRT在5d以上者。结论CRRT能有效控制ARF伴NODS患者的酸碱平衡、液体平衡及氮质血症；能有效降低部分细胞因子，抑制炎性反应；CRRT也是脏器功能支持的治疗方法,可能改善ARF伴NODS患者的预后。
Objective To investigate the effects of continuous renal replacement therapy （CRRT） in multiple organ dysfunction syndrome（MODS） patients with acute renal failure （ARF）, and its influences to the prognosis of these patients. Methods Forty-five MODS patients with ARF were treated by continuous veno-venous hemofiltration （CVVH）. The serum ereatinine （SCr）, blcod urea nitrogen （BUN）, uric acid（UA）, blcod routine test, C-reactive protein （CRP） were measured in the morning before initiation of CRRT and in the following four days after treatment with CRRT. Serun in-flammatory mediators, including tumor necrosis factor （TNF）-α, interleukin （IL） -4 and IL-6 were also measured before CRRT and at 6 h after treatment with CRRT. Hemodynamies, blood gas analysis and electrolyte were examined according to elimcal demands. Results The level of Cr, BUN and UA （P 〈 0.05） was significantly decreased after the treatment with CRRT. pH was maintained between 7.30 and 7.40, the blood electrolytes adjusted by displacement liquid were maintained in normal range. The levels of TNF-α, IL-4, IL-6 and CRP was obviously ameliorative （P 〈 0.05 ）. Twenty-six patients were survival, whose acute physiology and chronic health evaluation （APACHE）Ⅱ scores were smaller than 25 cents, failure organ number was under 3, the time of beginning CRRT after entering ICU was short, the age was young and received CRRT treatment more than 5 days. Conclusions CRRT can ef-ficiently control acid-base balance, fluid balance and asotemia in MODS patients with ARF. It has an effect to reduce the partial inflammatory mediators and restrain systematic inflammatory reaction. CRRT is an effective supporting treatment to organ function, it may improve the prognosis of MODS patients with ARF.
出处
《中国医师进修杂志（内科版）》
2007年第7期23-26,共4页
Chinese Journal of Postgraduates of Medicine
