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ID:53562902
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时间:2020-04-04
《连续肾替代治疗对心脏术后多器官功能障碍患者的救治(医学论文).doc》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
1、连续肾替代治疗对心脏术后多器官功能障碍患者的救治作者: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Treatmentonpostcardiacsurgerypatientswithmultiorgandysfunctionbycontinuousrenalreplacementtherapy(CRRT)[Abstract]AIM:Toinvestigatetheeffectivenessofcontinuousrenalreplacementtherapy(CRRT)inpostcardiopulmonarybypass(CPB)p
2、atientswithmultiorgandysfunctionsyndrome(MODS)andacuterenalfailure(ARF).METHODS:ThecirculationstabilityoftwentysevenpostCPBpatientswithMODSandARFwasmaintainedwithvascularactivedrugsandBM25continuousbloodpurificationsystemandM60filter(AN69membrane)wereusedtoperformthepredilutionc
3、ontinuousvenousvenoushemofiltration(CWH).Thedialysissolutionwasthesameasliterature・Thelowmolecularmassheparinwasusedforanticoagulation・Bloodflowwasabout200-250mL/minandthedialysissolutionflowratewas25-100mL/minforaneedof(39±10)Ldialysissolutionfor24htherapy.Theaveragetherapytime
4、was(52±13)h.Peripheralvenousbloodsampleswerecollectedbeforetherapyandat6:00a.m.everydayafterCRRTtodetecttheserumCr,Bun,HCO3-andK+.ArterialbloodsampleswerecollectedtodetecttheserumpHandHCO3-.TheCRRTwasstoppedwhentheurinevolumeofthepatientreached0.5mL/(kg・h)・RESULTS:Twentys
5、ixofthe27patientsrecoveredtheirnormalrenalfunctions・Sevenofthe11patientswithtwoorganfailureand3the10patientswiththreeorganfailuresurvivedthetherapy.Onlyoneofthe6patientswith4ormoreorgansfailuresurvived・Theoverallsurvivalratewas40%.CONCLUSION:CRRThasarelativelygoodeffectonthetrea
6、tmentofpatientsw辻hMODSandARFandcansignificantlyincreasethesurvivalrateofthesepatients・[Keywords]continuousrenalreplacementtherapy;multiorgandysfunctionsyndrome;acuterenalfailure;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
7、活性药物维持循环条件下,均采用BM25连续性血液净化系统,M60滤器(AN69膜)进行前稀释连续性静脉一静脉血液滤过(CWH),透析液参考季大玺等配方,低分子肝素抗凝,血流速度200-250mL/min,置换液流速25-100mL/min,24h总置换液量(39±10)L,平均治疗时间(52±13)h,所有患者在治疗前以及CRRT后的每日晨06:00外周静脉采血,检查肌肝(6),尿素氮(Bun)?碳酸氢根(HCO3J及血清钾离子(K+),动脉采血,检查pH值及HCO3-,当患者尿量达到0.5mL/(kg・h)时,停止CRRT.结果:27例
8、患者肾功能恢复26例,2脏器衰竭存活7例(7/11),3脏器衰竭存活3例(3/10),4脏器以
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