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目的观察连续性肾脏替代疗法(CRRT)治疗急肾衰(ARF)伴多脏器衰竭(MOF)的疗效,比较不同CRRT技术的优缺点及临床应用注意事项。方法 23例ARF伴MOF患者连续动静脉血液滤过(CAVH)11例,连续静静脉血液滤过透析(CVVH)(D)7例,日间连续性血液滤过透析(日间HDF)5例。结果均能满意控制水、钾和酸碱平衡,严重高分解代谢患者需同时透析。与血管通路有关及出血并发症仅见于CAVH组,而日间HDF组可出现低血压。死亡原因中,感染性休克最常见,占35.7%,急性呼吸窘迫综合征(ARDS)和胃肠道大出血各占21.4%。3例患者死于肾功能恢复期。结论 CRRT是治疗ARF伴MOF的有效方法,且患者耐受性较好,为原发病治疗和静脉营养的实施创造条件,可望改善预后。
Objective To observe the curative effect of continuous renal replacement therapy (CRRT) on acute renal failure (ARF) with multiple organ failure (MOF) and to compare the advantages and disadvantages of different CRRT techniques and clinical precautions. Methods Eleven patients with arterial and venous hemofiltration (CAVH), continuous venous hemofiltration (CVVH) (D) in seven patients and continuous hemofiltration (daytime HDF) in 23 ARF patients with MOF were enrolled in this study. . The results can be satisfied with the control of water, potassium and acid-base balance, severe catabolism in patients with simultaneous dialysis. Complications associated with vascular access and bleeding were found only in the CAVH group, while daytime HDF was associated with hypotension. Among the causes of death, septic shock was the most common, accounting for 35.7%, with ARDS and gastrointestinal bleeding accounting for 21.4%. Three patients died of kidney function recovery. Conclusion CRRT is an effective method for the treatment of ARF with MOF, and the patients are well tolerated. CRRT can create conditions for the treatment of primary disease and the implementation of intravenous nutrition, and is expected to improve the prognosis.