血液净化技术在ICU急性肾功能衰竭的应用

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患的血液净化治疗情况。比较不同治疗模式的疗效的并发症。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，并能持续于较低水平。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，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腺合并高脂血症的ARF患的有效方法。

Evaluation of different blood purification methods for acute renal failure in ICU

Objective To evaluate the effects and complications of different blood purification methods for acute renal failure(ARF) in ICU. Methods 20 patients who underwent blood purification therapy due to ARF in ICU were reviewed. The indication, effect and complication of different blood purification methods, namely the intermittent hemodialysis (IHD), continuous renal replacement therapy(CRRT) and pasma exchange(PE) were studied and compared. Results 5 patients received IHD. Three of them were cured and two died. Blood urea nitrogen(BUN), creatinine(Cr) and potassium dropped down rapidly after IHD, but with big fluctuation during dialysis interval. Fluid supplement was restricted. Two patients developed severe complications after IHD and died of them. CRRT was performed for 13 patients. BUN, Cr and potassium was cleared relatively slower but with less fluctuation, maintaining at a acceptable low level. Large amount of fluid supplement was allowed. CRRT improved hemodynamic situation and did not worsened the consciousness state of those with cerebral edema. 2 patients of acute severe pancreatitis accompanied by severe hyperlipidemia received unselec-tive plasma exchange(PE) and CRRT. Pancreatitis were controlled and renal function recovered. Conclusion The common IHD should be chosen carefully for severe case of ARF in ICU. CRRT seemed to be more suitable for them because of its efficacy and less complication. PE plus CRRT may be a good method for ARF caused by acute severe pancreatitis with hyperlipidemia.