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

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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