摘要
目的研究心脏外科手术后急性肾损伤(AKI)连续性肾脏替代治疗(CRRT)的效果。方法回顾性分析1998年1月至2008年10月上海交通大学附属第一医院49例心脏外科手术后AKI行连续性肾脏替代治疗患者的临床资料,分析治疗前后肾功能、电解质、酸碱平衡指标以及血流动力学指标的变化,并观察其临床转归。结果研究期间共行心脏手术4149例,术后早期出现AKI者159例,占同期手术总数的3.84%,行CRRT治疗者49例,占同期手术总数的1.18%,占AKI患者30.7%。49例患者连续性肾脏替代治疗后1d钾离子恢复正常,透析后3天尿素氮(17.32±6.17)mmol/L、肌酐(238.72±69.34)μmol/L较治疗前明显下降(P<0.05)且碳酸氢根浓度明显升高(22.19±3.92)mmol/L。患者血流动力学稳定。治疗后,25例患者存活,24例死亡,病死率为49.0%,其中AKI3期病死率最高达63%(P<0.05)。结论连续性肾脏替代治疗能有效改善患者内环境,降低患者病死率,且血流动力学稳定。尤其适用于治疗心脏手术后AKI,并且应尽可能早期进行干预。
Objective Aim is to investigate the therapeutic efficacy of continuous renal replacement therapy(CRRT)for acute renal injury(AKI)subsequent to cardiac surgical procedures.Methods Clinical data of 49 consecutive patients, admitted from Feb.1997 to Oct.2008,with AKI subsequent to cardiac surgery and undergone CRRT,were analyzed retrospectively. The general conditions of each patients including blood pressuer(BP ),heart rate(HR),and central vein pressure(CVP) were monitored every 30 minutes,and the blood gas analysis,serum biochemistry test were detected before and every 24 hours after the initiation of CRRT.Results Of 4149 consecutive patients undergone operations on heart,159 cases(3.84%)experienced AKI,and 49 cases(1.18%) required CRRT.In 49 patients performed CRRT, BUN and SCr were decreased,acid-base disturbance was corrected and the serum concentration of K+declined to normal level within one day.For the patients undergone CRRT,24 cases died,the mortality was 49%.Conclusion CRRT is an effective method for AKI patients subsequent to cardiac surgery and it should be performed as early as possible.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2009年第S2期57-59,共3页
Chinese Journal of Practical Internal Medicine
关键词
心脏外科手术
急性肾损伤
连续性肾脏替代治疗
cardiac surgical procedures
acute kidney injury
continuous renal replacement therapy
