季大玺 谢红浪 黎磊石 刘芸 徐斌 任冰 210002 南京军区南京总医院 解放军肾脏病研究所 中华内科杂志 1999 0 38 12


    关键词：肾功能衰竭，急性；预后；连续性肾脏替代治疗 期刊 zhnkzz 0 论 著 fur -->


    

【摘要 】 目的 回顾分析连续性肾脏替代疗法(CRRT)在重症急性肾功能衰竭(ARF)治疗中的应用和影响预后的因素。方法 1986年5月至1999年1月用CRRT治疗重症ARF患者101例，回顾性分析了患者临床特点、CRRT方法和预后。结果 101例患者中60例(59.4%)度过疾病的急性期(存活组)，41例(40.6%)在急性期死亡(死亡组)，对两组患者的临床统计学资料、肾功能衰竭的特点、疾病严重程度(APACHEⅡ)等因素作了分析，发现死亡组患者年龄更大、病情更重，需要机械通气和使用升压药患者数更多，肾前性和延迟发生的ARF比例更高，但少尿的患者数两组无差异。结论 (1)CRRT技术改革促进了其临床应用；(2)重症ARF预后受患者年龄、既往健康状况、病情严重程度、ARF特点等因素影响；(3)CRRT能改善肾性ARF患者的预后。

Treatment of severe acute renal failurewith continuous renal replacement therapy

    JI Daxi, XIE Honglang, LI Leishi, et al. Research Institute of Nephrology, JinlingHospital, Nanjing 210002

【Abstract 】 Objective Topresent the experience in 101 severe acute renal failure (ARF) patients treated withcontinuous renal replacement therapy (CRRT) in our hospital from May 1986 to January 1999.Methods Patients'age, sex, previous health status and characteristicsof renal failure were recorded. The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score were calculated before CRRT treatment. Results 60 (59.4%)patients survived the actue phase of their illness, and 41(40.6%) patients died. In thesurvival group, there were significantly less patients with pre-renal causes of renalfailure and refractory course of uremia, low APACHE Ⅱ score before treatment and lessneed of mechanical ventilation or vasoactive supporting. No difference was found in thepercentage of oliguria between the survival and total group. Conclusion CRRTis the treatment of first choice in ARF, especially in those complicated cases with severeparachymal renal diseases. The patients' age, previous health status, APACHEⅡ scorebefore CRRT, delayed occurrence of acute renal failure, need of mechanical ventilation andvasoactive drugs were predictors of a worse prognosis in severe ARF patient.The prognosisof renal type ARF patients improved with CRRT.

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