CAJ | 학술논문

目的探讨连续性血液净化(CBP)治疗心血管术后急性肾功能衰竭(ARF)的疗效.方法将入选病人按CBP实施前的病情严重程度分为全身炎症反应综合征(SIRS)组13例,多器官功能障碍(MODS)组12例;进行APACHEⅢ评分及常规检测血尿素氮(BUN)和血肌酐(Scr)水平,同时采用放射免疫分析法检测病人血浆中炎症介质白细胞介素(IL)6、肿瘤坏死因子8、(TNF-α)水平.结果 CBP实施24 h后APACHEⅢ评分、血BUN、血Scr,IL-6、8、TNF-α,均较CBP实施前显著降低[(分别为(61±15)vs(81±20),(19±5)mml/L vs(26±5)mmoVL,(312±87)/μmol/L vs(458±107)μmol/L,(544±154)ng/L vs(842±132)ng/L,(18±7)ng/L vs(25±8)ng/L,(43±15)ng/L vs(59±17)ng/L].SIRS、MODS组病人的存活率分别为84.62%、41.67%(P<0.05);CBP实施前和实施24 h后MODS组ARF病人的APACHEⅢ评分、血BUN、血Scr,血清IL6、IL-8均显著高于SIRS组.结论 APACHEⅢ评分为60～90分时可能是心血管术后发生ARF实施CBP治疗的较理想时机.
목적 탐토련속성혈액정화(CBP)치료심혈관술후급성신공능쇠갈(ARF)적료효.방법 장입선병인안CBP실시전적병정엄중정도분위전신염증반응종합정(SIRS)조13례,다기관공능장애(MODS)조12례;진행APACHEⅢ평분급상규검측혈뇨소담(BUN)화혈기항(Scr)수평,동시채용방사면역분석법검측병인혈장중염증개질백세포개소(IL)6、종류배사인자8、(TNF-α)수평.결과 CBP실시24 h후APACHEⅢ평분、혈BUN、혈Scr,IL-6、8、TNF-α,균교CBP실시전현저강저[(분별위(61±15)vs(81±20),(19±5)mml/L vs(26±5)mmoVL,(312±87)/μmol/L vs(458±107)μmol/L,(544±154)ng/L vs(842±132)ng/L,(18±7)ng/L vs(25±8)ng/L,(43±15)ng/L vs(59±17)ng/L].SIRS、MODS조병인적존활솔분별위84.62%、41.67%(P<0.05);CBP실시전화실시24 h후MODS조ARF병인적APACHEⅢ평분、혈BUN、혈Scr,혈청IL6、IL-8균현저고우SIRS조.결론 APACHEⅢ평분위60～90분시가능시심혈관술후발생ARF실시CBP치료적교이상시궤.
Objective To evaluate the effect and timing of continuous blood purification (CBP) in treatment of acute renal failure (ARF) following cardiac-vascular surgery. Methods Twenty-five patients with ARF following cardiac-vascular surgery were divided into systematic inflammatory response syndrome (SIRS) Group (n = 13) and multiple organ dysfunction syndrome (MODS) Group (n = 12) according to the illness state prior to CBP and were divided into Group A (n = 5, with the APACHE Ⅲ score prior to CBP≤60), Group B (n = 9, with the APACHE Ⅲ score 61 - 90), and Group C (n = 11, with the APACHE Ⅲ score 90 ) . All of the 25 patients underwent continuous veno-venous hemofiltration (CVVH). Before and 24h after the CVVH APACHEⅢ score was calculated and [peripheral; blood samples were collected to detect the levels of blood urea nitrogen (BUN) and serum creatinine (Scr) and the plasma levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-or (TNF-α). Results The APACHEⅢ score, BUN, Scr, IL-6, IL-8, and TNFα 24 h after the CBP of the 25 patients were 61±15 retool/L, (19±5) mmol/L, (312±87) μmol/L, (544±154) ng/L, (18±7) ng/L, and( 43±15 )ng/ L respectively, all significantly lower than those before CBP (81±20, 26± mmol/L, 458 ± 107 μmol/L, ( 842 ± 132) ng/L, (25 ± 8) ng/L, and (59 ± 17 ) ng/L respectively, all P =0.000). The survival rate of SIRS Group was 84.62%, significantly higher than that of MODS Group (41.67%, P < 0.05 ). The APACHEⅢ score, and the levels of BUN, Ser, IL-6, IL-8, and TNF-α of Group MODS were significantly higher than those of Group SIRS. The higher the level of Scr, IL-6, IL-8, and TNF-α and the APACHEⅢ score the lower the survival rate. Conclusion CBP has a positive effect on ARF following cardiac-vascular surgery. The APACHEⅢ score 60 to 90 reflects an opportunity to treat the ARF following cardiac-vascular surgery using CBP.