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目的研究连续性静-静脉血液滤过(CVVH)对全身炎性反应综合征(SIRS)合并急性肾衰竭(ARF)重症患者血流动力学的影响。方法选择第二军医大学附属长海医院肾内科16例SIRS合并ARF重症患者在明确诊断后行CVVH,平均治疗时间5日。采用股静脉留置单针双腔导管,建立血管通路、体外循环。使用Diapact CRRT机(Braun,德国),F60管道和血液滤过器(聚砜膜,1.2m2)。经桡动脉置管监测有创动脉压(MAP),经右侧颈内静脉置入Swan-Ganz导管。于CVVH治疗前和治疗后2h、4h、6h、结束后6h动态监测心率(HR)、肺毛细血管楔压(PAWP)、中心静脉压(CVP)、心排量(CO),并推算出心脏指数(CI)、体循环阻力(SVR)与肺血管阻力(PVR)。同时抽取静脉血检测电解质和肾功能。结果16例患者血流动力学指标除HR在CVVH后有显著下降,而MAP、PAWP、CVP、CO、CI、SVR及PVR各项指标无显著改变。治疗后BUN、Cr、K+有显著下降。16例患者存活11例,最后死亡5例。结论CVVH治疗能稳定患者的血流动力学变化,溶质清除较好,并发症少,可用于SIRS合并ARF的治疗。
Objective To investigate the effect of continuous intravenous hemofiltration (CVVH) on hemodynamics in patients with systemic inflammatory response syndrome (SIRS) and severe acute renal failure (ARF). Methods Sixteen patients with severe acute respiratory syndrome (SIRS) complicated with severe ARF in Department of Nephrology, Changhai Hospital affiliated to the Second Military Medical University were enrolled in the study. CVVH was performed after a definite diagnosis, with an average treatment time of 5 days. The femoral vein indwelling single-needle double-lumen catheter, the establishment of vascular access, cardiopulmonary bypass. Diapact CRRT machines (Braun, Germany), F60 tubing and hemofilter (polysulfone membrane, 1.2 m2) were used. Transcatheter arterial pressure (MAP) was monitored by radial artery catheterization, and a Swan-Ganz catheter was inserted through the right internal jugular vein. The heart rate (HR), pulmonary capillary wedge pressure (PAWP), central venous pressure (CVP) and cardiac output (CO) were measured before CVVH treatment and at 2h, 4h, 6h and 6h after the treatment. Index (CI), systemic resistance (SVR) and pulmonary vascular resistance (PVR). At the same time, venous blood was drawn for electrolyte and renal function tests. Results The hemodynamic indexes of 16 patients were significantly lower than HR after CVVH, while there was no significant change of MAP, PAWP, CVP, CO, CI, SVR and PVR. After treatment BUN, Cr, K + decreased significantly. 16 patients survived in 11 cases, the final death in 5 cases. Conclusion CVVH treatment can stabilize the hemodynamic changes of patients, solute removal is better, less complications, can be used for the treatment of SIRS with ARF.