摘要
目的探讨连续性肾脏替代疗法（CRRT）治疗模式静脉血液滤过（CVVH）和持续缓慢低效血液透析（SLED）对肝移植术后发生急性肾衰竭患者的疗效和安全性。方法所有患者资料均来源于上海市卫生局《急性肾衰竭的早期发现与防治》研究课题数据库。2004年1月-2005年12月,原位经典肝移植术后发生急性肾衰竭并需要进行透析治疗的患者共26例,其中6例行SLED（SLED组）,6例行滤过液剂量为35-40mL·kg^-1·h^-1的CVVH（CVVH-A组）,14例行滤过液剂量为50-60mL·kg^-1·h^-1的CVVH（CVVH-B组）。观察各组患者透析前后肾、肝功能和血流动力学等指标的变化;于治疗前、治疗第4天和治疗终止后,采用APACHEⅡ评分评估疾病严重性,比较各组患者存活和肾脏存活情况。结果单次治疗后各组肾、肝功能等指标明显改善（P〈0.05）;治疗前后血流动力学指标无显著差异（P〉0.05）。治疗第4天时各组间APACHEⅡ评分的差异无统计学意义（P〉0.05）;治疗终止后,CVVH-A组与CVVH-B组之间APACHEⅡ评分差异有统计学意义（10.8±4.6vs20.7±10.4,P=0.025）。SLED组、CVVH-A组和CVVH-B组的患者生存率分别为33.3%、66.7%和50.0%;肾脏存活率分别为66.7%、83.3%和50.0%,差异均无统计学意义（P〉0.05）。结论对肝移植术后发生急性肾衰竭的患者,CRRT和SLED均为安全且有效的治疗措施。
Objective To investigate the effects and safety of continuous renal replacement therapy（CRRT）[ continuous veno-venous hemofiltration（CVVH）as its principal treatment mode] and slow low efficiency dialysis（SLED） in patients with acute renal failure after orthotopic liver transplantation. Methods All the data were obtained from the Early Detection and Prevention of Acute Renal Failure Database,which was supported by the Medical Development Grant of Shanghai Municipal Health Bureau.From Jan 2004 to Dec 2005,26 patients with renal replacement therapy after orthotopic liver transplantation were included.Three groups were divided： SLED group（n=6）,CVVH-A group（diafiltration rate 35-40 mL·kg^-1·h^-1,n=6） and CVVH-B group（diafiltration rate 50-60 mL·kg^-1·h^-1,n=14）.Parameters such as renal function,liver function and hemodynamics were observed before and after dialysis in each groups.APACHEⅡ scoring was employed to evaluate the disease severity at the time points of pretreatment,the fourth day of treatment and posttreatment.The survival of patients and the survival of kidney were compared among groups. Results The parameters of renal function and liver function were significantly improved after dialysis（P〈0.05）.There was no significant difference in hemodynamics before and after dialysis（P〉0.05）.There was no significant difference in APACHEⅡ scores among each groups at the fourth day of treatment（P〉0.05）.However,there was significant difference in APACHEⅡ scores between CVVHF-A group and CVVH-B group at the end of treatment（10.8±4.6 vs 20.7±10.4,P=0.025）.The survival of patients was 33.3%,66.7% and 50.0%,and the survival of kidney was 66.7%,83.3% and 50.0%,respectively,with no significant difference among each groups（P〉0.05）. Conclusion CRRT and SLED are safe and effective therapy for patients with acute renal failure after liver transplantation.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2008年第8期1010-1014,共5页
Journal of Shanghai Jiao tong University:Medical Science
基金
上海市医学发展基金(2003ZD001)~~
