摘要
目的：探讨连续性肾脏替代治疗（ Ｃ Ｒ Ｒ Ｔ）技术在重症急性肾功能衰竭（ Ａ Ｒ Ｆ）及多器官功能障碍综合征（ Ｍ Ｏ Ｄ Ｓ）救治中的应用及其对预后的影响。方法：回顾性分析 １９８６ 年５ 月～１９９８ 年１２ 月用 Ｃ Ｒ Ｒ Ｔ 治疗了重症 Ａ Ｒ Ｆ及 Ｍ Ｏ Ｄ Ｓ患者１０１ 例，在 Ｃ Ｒ Ｒ Ｔ 装置、置换液配制和输入等方面作了系列改进。结果：１０１ 例患者中６０ 例（５９４％ ）度过疾病的急性期（存活组），４１ 例（４０６％ ）在急性期死亡（死亡组）。对２ 组患者人口统计学资料、肾功能衰竭的特点、疾病严重程度（ Ａ Ｐ Ａ Ｃ Ｈ ＥⅡ）等因素分析发现，死亡组患者年龄更大，既往健康状况更差，延迟发生的肾前性 Ａ Ｒ Ｆ患者所占比例更高。病情的严重程度表现为： Ａ Ｐ Ａ Ｃ Ｈ ＥⅡ评分更高，需要机械通气和升压药的比较更高；但２ 组少尿和 Ｃ Ｒ Ｒ Ｔ 持续时间无差异。结论：① Ｃ Ｒ Ｒ Ｔ 技术的改革扩展了临床应用范围；②重症 Ａ Ｒ Ｆ及 Ｍ Ｏ Ｄ Ｓ的预后受患者年龄、既往健康状况、病情严重程度、 Ａ Ｒ Ｆ特点等多种因素影响；③ Ｃ Ｒ Ｒ Ｔ 可以明显改善肾性 Ａ Ｒ Ｆ患者的预后。
Objective:To investigate the experience with 101 severe acute renal failure (ARF)and multiple organ dysfunction syndrome (MODS) patients treated with continuous renal replacement therapy (CRRT) in our hospital from May 1986 to December 1998.Methods:The patients′ age,sex,previous health status and characters of renal failure were recorded,the acute physiology and chronic health evaluation(APACHE)Ⅱ score were calculated before CRRT were analyzed.Results:60(59 4%) patients survived there acute phase of their illness,and 41(40 6%) patients died.In the survived group,there were significantly less patients with parachymal renal disease,refractory course of uremia,low APACHE Ⅱ score before treatment,and less need of mechanical ventilation or vasoactive supporting treatment.No difference was found in the percentage of oliguria between the survived and died group.Conclusions:CRRT should be the first choice in the treatment of ARF,especially in those complicated patients with severe parachymal renal diseases and MODS.The patients′ age,previous health status,APACHEⅡ score before CRRT,delayed occurrence of acute renal failure,need of mechanical ventilation and vasoactive drugs were predictors of a worse prognosis in severe ARF and MODS patient,the prognosis of renal type ARF patients were improved with CRRT.
出处
《中国危重病急救医学》
CSCD
1999年第9期550-553,共4页
Chinese Critical Care Medicine
关键词
连续性
肾脏替代治疗
肾功能衰竭
急性
治疗
continuous renal replacement therapy
acute renal failure
multiple organ dysfunction syndrome CLC number:R495.5
R692.5
Document code:A
Artical ID:10030603(1999)09055004
