Noguchi T, Uno T, Yoshitake S, Setoguchi K, Iwasaka H, Hayano Y, Oda S, Honda N
Department of Anesthesiology, Oita Medical University.
Masui. 1993 Feb;42(2):259-62.
The technical aspects of blood purification have made a great progress during 1980's. We reviewed our experiences of blood purification for the past six years. Between 1986 to 1991, we treated 48 perioperative patients with acute renal failure (ARF). Four were intraoperative cases and 46 were postoperative cases. Three of four intraoperative patients received major cardiovascular surgery, and hemodialysis was connected directly to ECC in these three cases, and in other one case, ARF was treated with continuous hemofiltration (CHF). There was no intraoperative complication. One patient died of septic multiple organ failure (MOF), but other three patients were discharged uneventfully. Thirty five postoperative ARF patients showed oliguric ARF, and their major causes were LOS (65%) and septic shock (29%). We treated these ARF patients with CHF combined with HD (63%), CHF only (28%) and HD only (9%). There were 21 deaths (60%) in this group and most common cause of death was septic MOF. Eleven postoperative ARF patients showed non-oliguric renal failure, and major cause of this type of ARF was thought to be aortic dissection and relative hypotension (45%). We treated these non-oliguric ARF patient with HD only (73%) and HD combined with CHF (27%). One of these non-oliguric ARF patients died from ARDS.
20世纪80年代，血液净化技术取得了巨大进展。我们回顾了过去六年血液净化的经验。1986年至1991年间，我们治疗了48例围手术期急性肾衰竭（ARF）患者。其中4例为术中病例，46例为术后病例。4例术中患者中有3例行重大心血管手术，这3例患者的血液透析直接与体外循环（ECC）相连，另1例患者采用持续血液滤过（CHF）治疗ARF。术中无并发症发生。1例患者死于感染性多器官功能衰竭（MOF），但其他3例患者顺利出院。35例术后ARF患者表现为少尿型ARF，其主要原因是肺部感染（65%）和感染性休克（29%）。我们采用CHF联合HD（63%）、单纯CHF（28%）和单纯HD（9%）治疗这些ARF患者。该组有21例死亡（60%），最常见的死亡原因是感染性MOF。11例术后ARF患者表现为非少尿型肾衰竭，这类ARF的主要原因被认为是主动脉夹层和相对低血压（45%）。我们仅采用HD（73%）和HD联合CHF（27%）治疗这些非少尿型ARF患者。其中1例非少尿型ARF患者死于急性呼吸窘迫综合征（ARDS）。
