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目的 探讨ICU复杂性急性肾功能衰竭(ARF)血液净化治疗模式的选择及疗效和并发症。方法回顾性分析1999年1月～2001年12月在我院ICU收治的20例ARF患者的血液净化治疗情况。比较不同治疗模式的疗效和并发症。结果 5例接受普通间歇性血液透析(IHD))治疗。3例治愈,2例死亡。血尿素氮(BUN)、肌酐(Cr)和血钾透析后均明显下降,但透析间期波动大。补充的液体量受限制。2例透析后出现严重的并发症并死亡。13例行连续性肾脏替代治疗(CRRT),血BUN、Cr和血钾缓慢下降,波动小,并能维持于较低水平。允许补充大量液体和静脉营养。CRRT还能改善血流动力学状态,不加重脑水肿患者的意识障碍。2例急性重症胰腺炎合并高乳糜微粒血症的ARF患者接受非选择性血浆置换(PE)加CRRT治疗,胰腺炎得以较快控制,肾功能逐渐恢复。结论 对于ICU的重症ARF患者,选择IHD应慎重。CRRT更适合复杂性ARF的肾替代治疗。血浆置换联合CRRT可能是治疗急性重症胰腺合并高脂血症的ARF患者的有效方法。
Objective To investigate the curative effect and complications of ICU complicated acute renal failure (ARF) blood purification. Methods A retrospective analysis of blood purification treatment in 20 ARF patients admitted to our hospital from January 1999 to December 2001 was performed. Compare the efficacy and complications of different treatment modalities. Results Five patients underwent general intermittent hemodialysis (IHD). Three were cured and two died. Blood urea nitrogen (BUN), creatinine (Cr) and serum potassium after dialysis were significantly decreased, but the dialysis interval fluctuations. The amount of fluid to replenish is limited. Two patients experienced severe complications and died after dialysis. 13 cases of continuous renal replacement therapy (CRRT), blood BUN, Cr and potassium decreased slowly, small fluctuations, and can be maintained at a low level. Allow plenty of fluid and parenteral nutrition. CRRT also improves hemodynamic status without increasing disturbance of consciousness in patients with cerebral edema. Two patients with acute severe pancreatitis complicated with hyperchylomicronemia underwent non-selective plasma exchange (PE) and CRRT. The pancreatitis was rapidly controlled and the renal function recovered gradually. Conclusions ICD should be carefully selected for patients with severe ARF in ICU. CRRT is more suitable for renal ARF replacement therapy. Plasma exchange combined with CRRT may be an effective method for the treatment of ARF patients with acute severe pancreas complicated with hyperlipidemia.