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目的探讨连续性血液净化(CBP)治疗心脏术后急性肾衰竭(ARF)的有效性及最佳时机。方法 21例患者心脏术后因急性肾衰竭接受连续性血液净化(CBP)治疗,根据预后分为生存组(n=13)和死亡组(n=8),对其临床资料进行回顾性分析比较。对两组患者治疗前进行APACHEⅢ评分,并分别观察两组患者治疗前、治疗12、24、48和72 h后肾功能(BUN、Cr)、心肌酶(AST、CPK、LDH)、左心射血分数(LVEF)、心脏输出量(CO)、心脏指数(CI)的变化以及平均动脉压(MAP)、心率(HR)、氧合指数(PaO2/FiO2)、血乳酸(Lac)、WBC和P1t等指标,观察治疗前及治疗期间的白细胞介素6(IL-6),白细胞介素8(IL-8),肿瘤坏死因子(TNF-α)等炎症因子的变化。结果 21例患者中存活13例,死亡8例。两组患者治疗前APACHEⅢ评分、MAP、Lac、BUN、Cr及CPK、AST差异存在统计学意义(P<0.05)。经CBP后两组患者BUN、Cr和心肌酶、MAP、PaO2/FiO2、CO、CI、LVEF较治疗前均有明显改善(P<0.05),而HR、WBC和P1t治疗前后变化不明显(P>0.05),IL-6、IL-8、TNF-α等炎症介质明显下降(P<0.05)。结论 CBP能显著改善肾功能以及心脏功能,减少炎症因子的释放。早期诊断ARF,尽早进行CBP治疗有助于减少其他并发症的发生,提高生存率。
Objective To investigate the effectiveness and optimal timing of continuous blood purification (CBP) for acute renal failure (ARF) after cardiac surgery. Methods Twenty-one patients were treated with continuous blood purification (CBP) after acute cardiac failure and were divided into survival group (n = 13) and death group (n = 8) according to the prognosis. The clinical data were retrospectively analyzed . The APACHE III scores of two groups before treatment were observed and the changes of renal function (BUN, Cr, AST, CPK, LDH), left ventricular ejection fraction (LVEF), cardiac output (CO), cardiac index (CI) and mean arterial pressure (MAP), heart rate (HR), oxygenation index (PaO2 / FiO2), blood lactate P1t and other indicators were observed before and during treatment of interleukin 6 (IL-6), interleukin 8 (IL-8), tumor necrosis factor (TNF-α) and other inflammatory cytokines change. Results Of the 21 patients, 13 survived and 8 died. APACHE Ⅲ score, MAP, Lac, BUN, Cr, CPK and AST before treatment in both groups were statistically significant (P <0.05). The levels of BUN, Cr, CK, MAP, PaO2 / FiO2, CO, CI and LVEF in both groups after CBP were significantly improved compared with before treatment (P <0.05) > 0.05), IL-6, IL-8, TNF-α and other inflammatory mediators decreased significantly (P <0.05). Conclusion CBP can significantly improve renal function and cardiac function, reduce the release of inflammatory cytokines. Early diagnosis of ARF, CBP as soon as possible to help reduce the incidence of other complications and improve survival.