摘要
目的探讨连续性肾脏替代治疗（CRRT）在MICU非肾性危重患者中应用的疗效及安全性。方法选择内科重症监护室（MICU）实施CRRT患者29例，均采用Prisma机器以及配套的管路和滤器，血管通路均采用股静脉或颈内静脉留置双腔导管，根据患者情况选择连续静静脉血液滤过（CVVH）、连续静静脉血液透析滤过（CVVHDF），透析持续时间每日4—12h，如病情需要则24h持续进行，血流速100～180ml／h，置换液30—50L／次；每次脱水量根据病情设置0～4kg。观察治疗前后临床症状、血流动力学、血生化、氧合指数（PaO2／FiO2）和pH值、前炎性细胞因子肿瘤坏死因子-α（TNF-α）的变化及APAcHE Ⅱ评分，并监测治疗过程中的并发症。结果26例患者在CRRT治疗后生命体征迅速稳定，血滤前：体温（37．6±0．88）℃、呼吸频率（110．3±19．54）次／min、氧合指数262．6±10．6、白细胞总数（11．33±2．27）×10^9／L、中性粒细胞比例（85．62±7．83）％、天冬氨酸氨基转移酶（AST）（74．58±19．34）U／L、APACHE Ⅱ评分24．37±9．23分，血滤后：体温（36．84±0．58）℃、呼吸频率（102．0±16．2）次/min、氧合指数373．2±11．2、白细胞总数（9．62±3．26）×10^9／L、中性粒细胞比例（71．58±10．54）％、AST（38．34±13．96）U／L、APACHE Ⅱ评分14．65±6．54分，血滤前后相比差异具有统计学意义（t值分别为2．04、1．76、38．62、2．31、5．76、8．18、1．59。P均〈0．05），治疗过程中患者严重的离子及酸碱紊乱纠正，无其他并发症的发生。结论CRRT治疗能够降低患者炎性反应程度，改善器官功能水平，稳定内环境，且血流动力学稳定，未见严重并发症的发生，安全有效。CRRT对于非肾性危重症患者来说是一个基本的治疗工具和重要的支持疗法。
Objective To investigate the clinical effect and safety of the application of contitunous renal replacement therapy （CRRT） in non-kidney severe patients in MICU. Methods Twenty-nine cases who underwent the CRRT in MICU were included in the study. Vessel pathway were all through inserting double channel catheter in femoral vein or internal carotid vein. According to the patient＇s condition,patients were treated by slow continuous ultrafiltration（CVVH） or continuous veno-venous hemodialysis （CVVHDF）. The duration was 4- 12 hours or continuation if necessary. The volume of blood flow was 100 - 180 mL/h. The displacement liquid was 30 - 50 ml/ time. The volume of dehydration was 0 -4 kg according to the patient＇s condition. The clinical symptoms, hemodynamics,blood biochemistry, PaO2/FiO2, pH, tumor necrosis factor and acute physiology and chronic health evaluation （APACHE） Ⅱ were observed before and after therapy. The complications were monitored. Results The vital signs of the patients became stable shortly after CRRT therapy, before CRRT temperature （ 37.6 ± 0. 88 ）℃, respiratory rate （ 110. 3 ± 19. 54 ） time/min, the oxygention index （262. 6 ± 10. 6）, WBC （ 11.33 ± 2. 27 ） × 10^9/L, NE （85.62 ± 7.83 ） %, AST （ 74. 58 ± 19.34 ） U/L, APPACHE Ⅱ score （ 24. 37 ± 9. 23 ）, after CRRT temperature 〉 （ 36. 84 ± 0. 58 ） ℃, respiratory rate （ 102. 0 ± 16. 2 ） times/min, the oxygention index （ 373.2 ± 11.2 ）, WBC （9.62 ±3.26） ×10^9/L, NE （71.58 ± 10. 54 ） % , AST （38.34 ± 13.96 ） U/L, APACHE Ⅱ score （ 14. 65 ± 6. 54 ）. There were significantly difference between the indices at before and after treatment （ P 〈 0. 05 ）. Serious ions and acid base abnormality were rectified during CRRT therapy without any severe complications. Conclusions CRRT therapy could decline the level of infections reaction and improve organs＇ function, adjust the balance of internal environment, stable hemodynamics without any severe complicat
出处
《中国综合临床》
2010年第5期518-521,共4页
Clinical Medicine of China
关键词
连续性肾脏替代治疗
非肾脏疾病
内科重症监护室
Continuous renal replacement therapy
Non-kidney disease
Medical intensive care unit
