Kluczewski Grzegorz, Gierek Danuta, Kaczmarska Adriana, Cyzowski Tomasz, Dąbek Józefa, Krzych Lukasz
Department of Anaesthesiology and Intensive Therapy, Medical University of Silesia in Katowice, Katowice-Ochojec.
Anestezjol Intens Ter. 2011 Apr-Jun;43(2):80-4.
Continuous veno-venous haemofiltration (CVVH) has been recommended for renal replacement therapy in acute renal failure (ARF). The aim of the study was to analyse the usefulness of CVVH in intensive therapy settings.
Sixteen adult patients, treated with CVVH because of ARF complicating multiple organ failure, were allocated to two groups: those who survived and those who did not. Serum lactate, creatinine, potassium, and C-reactive protein concentrations, together with WBC count and arterial blood gases, were assessed before the start of CVVH, and daily during the therapy. The severity of the patients' clinical state was rated according to the Sepsis-related Organ Failure Assessment scale (SOFA) at both the initiation and the termination of therapy.
The demographic data did not differ between the groups. Mean serum creatinine (171.5 vs 282.9 mmol L-1, p<0.05), blood lactate (1.8 vs 3.5 mmol L-1, p<0.05), and potassium concentrations (3.9 mmol L-1 vs 4.5 mmol L-1, p<0.05) were significantly higher in those patients who died. Mean SOFA scores were similar in both groups before the start of treatment, but were increased significantly at the end of therapy in the patients who died (7.0 vs 15.0, p<0.05). The concentrations of CRP, and WBC counts were similar in both groups.
We concluded that CVVH can be instituted in cases of ARF, regardless of age or condition of patients. Early institution of CVVH was effective and resulted in normalization of renal function and biochemical parameters.
连续性静脉-静脉血液滤过（CVVH）已被推荐用于急性肾衰竭（ARF）的肾脏替代治疗。本研究的目的是分析CVVH在重症治疗环境中的有效性。
16例因ARF并发多器官功能衰竭而接受CVVH治疗的成年患者被分为两组：存活组和死亡组。在CVVH开始前及治疗期间每天评估血清乳酸、肌酐、钾和C反应蛋白浓度，以及白细胞计数和动脉血气。根据脓毒症相关器官功能衰竭评估量表（SOFA）在治疗开始时和结束时对患者的临床状态严重程度进行评分。
两组间人口统计学数据无差异。死亡患者的平均血清肌酐（171.5对282.9 mmol/L，p<0.05）、血乳酸（1.8对3.5 mmol/L，p<0.05）和钾浓度（3.9 mmol/L对4.5 mmol/L，p<0.05）显著更高。两组治疗开始前的平均SOFA评分相似，但死亡患者在治疗结束时显著升高（7.0对15.0，p<0.05）。两组的CRP浓度和白细胞计数相似。
我们得出结论，无论患者年龄或病情如何，ARF病例均可采用CVVH治疗。早期应用CVVH有效，可使肾功能和生化指标恢复正常。
