Clinical efficiency and safety of the application of continuous renal replacement therapy in non-kidney severe patients in MICU / 中国综合临床

ABSTRACT

Objective To investigate the clinical effect and safety of the application of contitunous renal replacement therapy (CRRT) in non-kidney severe patients in MICU.Methods Twenty-nine cases who underwent the CRRT in MICU were included in the study.Vessel pathway were all through inserting double channel catheter in femoral vein or internal carotid vein.According to the patient's condition,patients were treated by slow continuous ultrafiltration( CVVH )or continuous veno-venous hemodialysis (CVVHDF).The duration was 4-12 hours or continuation if necessary.The volume of blood flow was 100-180 ml/h.The displacement liquid was 30-50 ml/time.The volume of dehydration was 0-4 kg according to the patient's condition.The clinical symptoms,hemodynamics,blood biochemistry,PaO2/FiO2,pH,tumor necrosis factor and acute physiology and chronic health evaluation (APACHE) Ⅱ were observed before and after therapy.The complications were monitored.Results The vital signs of the patients became stable shortly after CRRT therapy,before CRRT temperature ( 37.6 ± 0.88 ) ℃,respiratory rate ( 110.3 ± 19.54)time/min,the oxygention index (262.6 ± 10.6),WBC ( 11.33 ± 2.27) × 109/L,NE (85.62 ± 7.83 ) %,AST ( 74.58 ± 19.34 ) U/L,APPACHE Ⅱ score ( 24.37 ± 9.23 ),after CRRT temperature ＞( 36.84 ± 0.58 ) ℃.respiratory rate ( 102.0 ± 16.2 ) times/min,the oxygention index ( 373.2 ± 11.2),WBC (9.62 ±3.26) × 109/L,NE (71.58 ± 10.54) %,AST(38.34 ± 13.96) U/L,APACHE Ⅱ score ( 14.65 ± 6.54).There were significantly difference between the indices at before and after treatment ( P ＜ 0.05 ).Serious ions and acid base abnormality were rectified during CRRT therapy without any severe complications.Conclusions CRRT therapy could decline the level of infections reaction and improve organs' function,adjust the balance of internal environment,stable hemodynamics without any severe complication after treatment.CRRT is safe and effective.In conclusion,CRRT is a primary treatment and an important supportive therapy.