连续肾替代治疗对心脏术后多器官功能障碍患者救治.docVIP

连续肾替代治疗对心脏术后多器官功能障碍患者救治 　 作者：崔勤,赵荣,金振晓,张胜利,郑霄,张赤铭 【关键词】 连续肾替代治疗 Treatment on post cardiac surgery patients with multiorgan dysfunction by continuous renal replacement therapy (CRRT) 　　【Abstract】 AIM: To investigate the effectiveness of continuous renal replacement therapy (CRRT) in post cardiopulmonary bypass (CPB) patients with multiorgan dysfunction syndrome (MODS) and acute renal failure (ARF). METHODS: The circulation stability of twentyseven post CPB patients with MODS and ARF was maintained with vascular active drugs and BM25 continuous blood purification system and M60 filter (AN69 membrane) were used to perform the predilution continuous venousvenous hemofiltration (CVVH). The dialysis solution was the same as literature. The low molecular mass heparin was used for anticoagulation. Blood flow was about 200-250 mL/min and the dialysis solution flow rate was 25-100 mL/min for a need of (39±10) L dialysis solution for 24 h therapy. The average therapy time was (52±13) h. Peripheral venous blood samples were collected before therapy and at 6:00 a.m. everyday after CRRT to detect the serum Cr, Bun, HCO3- and K+. Arterial blood samples were collected to detect the serum pH and HCO3-. The CRRT was stopped when the urine volume of the patient reached 0.5 mL/（kg#12539;h）. RESULTS: Twentysix of the 27 patients recovered their normal renal functions. Seven of the 11 patients with twoorgan failure and 3 the 10 patients with threeorgan failure survived the therapy. Only one of the 6 patients with 4 or more organs failure survived. The overall survival rate was 40%. CONCLUSION: CRRT has a relatively good effect on the treatment of patients with MODS and ARF and can significantly increase the survival rate of these patients. 　　【Keywords】 continuous renal replacement therapy； multiorgan dysfunction syndrome；acute renal failure；therapy 　　【摘要】 目的： 探讨连续肾替代治疗(CRRT)对体外循环手术后多器官功能障碍综合征(MODS)伴急性肾功能衰竭(ARF)患者的救治作用. 方法：体外循环手术后MODS伴ARF患者27例，在血管活性药物维持循环条件下，均采用BM 25连续性血液净化系统，M60滤器(AN69膜