Our Experience of Continuous Renal Replacement Therapy in Burned Patients with Acute Renal Failure

使用連續性腎臟取代透析療法(CRRT)在合併急性腎衰竭的燒傷病人之經驗

孫一峯(I-Feng Sun) ； 李書欣(Su-Shin Lee) ； 林才民(Tsai-Ming Lin) ； 李孝貞(Hsiao-Chen Lee) ； 賴春生(Chung-Sheng Lai) ； 林幸道(Sin-Daw Lin)

《中華民國整形外科醫學會雜誌》 14卷1期 (2005/03) Pp. 49-57

https://doi.org/10.7096/JPSA.200503.0049

摘要

急性腎衰竭是由於腎功能急速降低所表現出來的臨床症狀。急性腎衰竭在燒傷病患的發生率介於0.5%到30%間。然而，其死亡率卻高達百分之七十三至一百。腹膜透析、傳統血液透析及連續性腎臟取代透析療法都是治療急性腎衰竭的方法。一般而言，當病人因爲低血壓而無法接受傳統血液透析治療或病人因爲腹部燒傷而不適合接受腹膜透析治療時，連續性腎臟取代透析療法是一種相當好的治療方式。自2001年至2004年，有三位住進本院燒傷中心病患因為急性腎衰竭而接受連續性腎臟取代透析療法-CVVH(continuous venovenous hemofiltration)。所有的病人都是男性。平均年齡是61歲(41~80)歲。平均燒傷面積是47%(30%~71%)。經過治療後，有兩位病患的腎功能從急性腎衰竭的狀况下回復過來。其中一位順利出院，另一位先前罹患心臟血管疾病的病人則在住院中由於急性心肌梗塞死亡。我們分析連續性腎臟取代透析療法在合併急性腎衰竭的燒傷病人的使用經驗，並討論其適應症、禁忌、優點、缺點及併發症。

並列摘要

Acute renal failure (ARF) is characterized by rapid decline in renal function, especial decreasing glomerular filtration rate. The incidence of ARF in burns patients varies widely between 0.5 and 30 per cent depending on patient's age and severity of injury. Many studies have reported a high mortality rate from 73% to 100%. Peritoneal dialysis, intermittent hemodialysis, and continuous renal replacement therapy (CRRT) are methods to treat ARF. In general, continuous renal replacement therapy is used for patients in whom intermittent hemodialysis fails to control hypovolemia, and for those who do not tolerate intermittent hemodialysis and in whom peritoneal dialysis is not suitable owing to burnt abdominal area. Three burn patients received continuous renal replacement therapy-CVVH (continuous venovenous hemofiltration)-in our burn unit from 2001 to 2004. All of these patients were male with a mean age of 61 year (41~80) and a mean burned surface area of 47% (30~71). Two patients recovered from the course of acute renal failure: one patient expired due to acute myocardial infarction during hospitalization, the other patient survived. We analysis the usage of continuous renal replacement therapy for burned patient with ARF and discuss its indication, contraindication, advantages, disadvantages and complications.

並列關鍵字

acute renal failure (ARF) ； continuous renal replacement therapy (CRRT) ； continuous venovenous hemofiltration (CVVH)