The therapeutic efficacy of continuous blood purification for severe acute renal failure after cardiac surgery / 中国医师杂志

ABSTRACT

Objective To evaluate the efficiency and the timing of continuous blood purification(CBP) in patients with multiple or-gan dysfunction syndrome(MODS) and acute renal failure(ARF) following cardiac surgery. Methods From November,2003 to July,2007,thirty-one patients with MODS and ARF following cardiac surgery were treated with CBP. They were divided into two groups, alive group ( group A) and dead group ( group B). Clinical data of the two groups were reviewed. Before CBP, duration of extracorporeal circulation, du-ated. Mean arterial pressure (MAP), heart rate (HR), oxygenic index (PaO2/FiO2), white blood cell count (WBC), platelet count (PLT) and renal function (blood urea nitrogen, BUN, ercatinine, Cr) were observed before and after CBP. Results The number of im-paired organs of patients in group B was significantly more than that in group A before CBP ( P＜0.05). MODS scores ( 12.9±3.2 vs 6.9 ±2.3, P＜0.05) and APACHE Ⅱ scores (26.3±10.4 vs 17.2±5.1, P＜0.05)of group B were significantly higher than those of group A before CBP. After treatment of CBP for 24 hours, APACHE Ⅱ scores and MODS scores only significantly decreased in group A (P＜0.05 ). After treatment of CBP, Cr and BUN significantly reduced, while MAP and PaO2/FiO2 increased, in all patients, but HR was signif-icantly lower than that before CBP in group A (P＜0.05). The duration of ARF (34.67±32.79 hours vs 13.05±14.09 hours,P＜cantly higher than those of group A. Conclusion MODS scores and APACHE II scores can be used to evaluate the severity of patients with MODS and ARF after cardiac surgery. CBP is an effective treatment for these patients. It is suggested that early CBP therapy is important for reducing the chances of the multiple organ dysfunction syndrome and mortality of these patients.