Dubrov A I, Mazin V V, Martynov L V
Akush Ginekol (Mosk). 1991 Feb(2):46-50.
The examination of 45 patients with acute renal failure (ARF) caused by obstetric problems identified 3 types of its clinical course: 1) "pure" ARF; 2) ARF in the presence of sepsis, and 3) ARF in the presence of exogenous intoxication. Types 2 and 3 were more severe and showed higher mortality rates. The average number of hemodialysis sessions per patient was 2.4, 3.6, and 9.8 with types 1, 2, and 3, respectively. The treatment was of multimodality, including suppurative focus debridement, therapeutic measures, hemodialysis, and hyperbaric oxygenation; with types 2 and 3 efforts were made to combat sepsis, hemodynamic and coagulative abnormalities, multiorgan failure. The operative risk during evolved ARF is extremely high; uterine curettage, rational bacterial therapy, refusal of nephrotoxic agents are preferred. Better treatment outcomes were due to a session of 5-10 hyperbaric oxygenation procedures which were performed in anaerobic sepsis, pulmonary edema, arterial hypoxemia. The patients who had received hyperbaric oxygenation had less severe ARF, lower incidence of complications and lower mortality rates, they tolerated hemodialysis better.
对45例由产科问题导致急性肾衰竭(ARF)的患者进行检查后,确定了其临床病程的3种类型:1)“单纯性”ARF;2)伴有脓毒症的ARF;3)伴有外源性中毒的ARF。第2型和第3型更为严重,死亡率更高。第1型、第2型和第3型患者平均透析次数分别为2.4次、3.6次和9.8次。治疗采用多模式,包括清除化脓病灶、采取治疗措施、进行血液透析和高压氧治疗;对于第2型和第3型患者,努力对抗脓毒症、血流动力学和凝血异常以及多器官功能衰竭。进展期ARF期间的手术风险极高;刮宫术、合理的抗菌治疗、避免使用肾毒性药物更为可取。更好的治疗效果归因于在厌氧性脓毒症、肺水肿、动脉血氧不足时进行5 - 10次高压氧治疗。接受过高压氧治疗的患者急性肾衰竭病情较轻,并发症发生率较低,死亡率也较低,他们对血液透析的耐受性更好。