关键词: 连续性血液净化；心脏术后;急性肾衰竭

Abstract:

Objective   To evaluate the effect of continuous blood purification(CBP) on acute renal failure(ARF)  following cardiac surgery. Methods   According to the prognosis, 21 patients with ARF after cardiac surgery who underwent CBP from August 2005 to May 2010 were divided into the live group(n=13) and the dead group(n=8). Clinical data from the two groups were reviewed. APACHEⅢ scores were evaluated before CBP. Blood urea nitrogen(BUN), creatinine (Cr) and myocardial enzymes, aspartate aminotransferase(AST), creatine phosphokinase( CPK), and lactate dehydrogenase (LDH) as well as left ventricular ejection fraction(LVEF), cardiac output(CO), cardiac index(CI), mean arterial pressure(MAP), heart rate(HR),oxygenic index (PaO2/FiO2), blood lactate(Lac), white blood cell count(WBC), platelet count(Plt), interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α (TNF-α) were determined before and 12, 24, 48 and 72 hours after CBP. Results   13 patients were alive and 8 were dead in the end. APACHEⅢ scores in the dead group were significantly higher than those in the live group before CBP(P<0.05)．Compared with the live group, there were significant differences in LVEF, CO, CI, MAP,  Lac,  BUN, Cr, CPK and AST in the dead group before CBP(P<0.05). After CBP, there was a significant improvement in BUN, Cr, myocardial enzymes, LVEF,CO,CI,MAP,PaO2/FiO2, and a significant decrease in IL-6, IL-8 and TNF-α(P<0.05)，while there was no significant difference in HR, WBC and Plt(P>0.05)．Conclusions   CBP is an effective treatment for ARF following cardiac surgery, improving cardiac and renal function and decreasing release of inflammatory mediators．The earlier diagnosis of ARF after cardiac surgery and earlier treatment with CBP might greatly reduce the incidence of other complications, such as multiple organ dysfunction syndrome, and increase survival of patients.

Key words: Continuous blood purification；   After cardiac surgery；   Acute renal failure