摘要
目的比较目标导向肾脏替代疗法（GDRRT）与每日高容量血液滤过（dHVHF）治疗心脏手术后急性肾损伤（AKI）的疗效及其安全性。方法回顾性分析2002年1月至2010年9月128例心脏手术后发生AKI，并接受肾脏替代治疗（RRT）患者的临床资料，比较GDRRT与dHVHF后的临床转归和不良事件发生率等。结果GDRRT组（64例）和dHVHF组（64例）患者院内病死率均为43．75％；28d病死率GDRRT组略低，但差异无统计学意义（43．75％比57．81％，P=0．055），dHVHF组住重症监护病房（ICU）时间（h）和机械通气时间（d）均明显长于GDRRT组[356．5（176．3，554．6）比238．3（119．6，440．9），P=0．023；8．0（5．0，16．0）比6．0（3．0，13．5），P=0．0423。两组住院时间无明显差异。采用logistic多因素回归分析校正混杂因素后，GDRRT组肾功能完全恢复率显著高于dHVHF组（39．1％比18．8％，P〈0．01）；肾功能部分恢复率低于dHVHF组，但差异无统计学意义（3．1％比9．4％，P〉0．05）。dHVHF组RRT治疗期间血肌酐（SCr）最高值及出院时SCr值均显著高于GDRRT组（／zmol／L：最高值559．0i236．0比440．4±192．0，出院值381．4±267．0比271．25=164．4，均P〈0．01）。RRT治疗72h内GDRRT组和dHVHF组低血压发生率、平均动脉压（ramHg，1mmHg=0．133kPa）差异无统计学意义（35．9％比37．5％，82±13比81±15，均P〉0．05）；dHVHF组心动过速及凝血事件发生率高于GDRRT组（78．1％比59．4％，35．9％比20．3％，均P〈0．05）。dHVHF组住院期间治疗费用（万元）明显高于GDRRT组（1．500±0．280比0．985±0．300，P〈0．01）。结论GDRRT治疗心脏术后AKI安全有效，短期生存率及安全性与dHVHF相近，而在改善肾脏预后方面的作用及降低治疗费用均优于dHVHF。
Objective To eompare the effieacy and safety of goal-directed renal replacement therapy （GDRRT） and daily high volum hemofiltration （dHVHF） in the treatment of acute kidney injury （AKI） after cardiac surgery. Methods Clinical data from 128 patients received either GDRRT （n = 64） or dHVHF （n=64） for AKI after eardiac surgery were analyzed retrospeetively. Parameters examined included., urea nitrogen, serum ereatinine （SCr, before and after treatment）, heart rate, mean artery pressure （MAP, recorded within 72 hours after the initiation of renal replacement therapy）. The hospital mortality, day-28 mortality, renal funetion recovery rate, and the ineidence of adverse events in the two groups were also compared. Results The hospital mortality was 43.75; for both GDRRT and dHVHF treated patients （group）. The day-28 mortality in GDRRT group were slightly lower, but the difference was not significant （43.75% vs. 57.81%, P： 0. 055）. Also no significant difference was found between the two groups in hospital stay. The patients received dHVHF had longer intensive eare unit （ICU） stay （hours） and duration of meehanieal ventilation （days） as compared to the patients reeeived GDRRT [356.5 （176.3, 554. 6） vs. 238.3 （119.6, 440.9）, P=0.023, 8.0 （5.0, 16.0） vs. 6.0 （3.0, 13.5）, P=0.0423. The logistic regression analyses showed that complete renal function recovery rate in GDRRT group was significantly higher （39.1; vs. 18.8%, P;0.01）. The partial renal function recovery rate in GDRRT group was slightly lower but not statistically different from dHVHF group （3.1% vs. 9.4%, P〉0. 05）. In dHVHF group, the maximun SCr during the treatment, and the SCr before discharge were both signifieantly higher than GDRRT group （μmol/L , SCr maximun 559.0± 236.0 vs. 440. 4±192.0, SCr before dis eharge 381.4± 267.0 vs. 271.2±164.4, both P〈0. 01）. No significant difference was found between the two groups in ineidenee of hypotension （35.9% vs. 37.5% and MAP （mm Hg, 1 mm Hg=0. 133 kPa, 82±13 vs. 81± 15） 72 hours into the therapy （both P〉 0.05）. The incidence of tachycardia, and incidence of blood coagulation were both higher in dHVHF group （78.1% vs. 59.4%, 35.9% vs. 20. 3%, both P〈0. 05）. However, the hospitalization expense （thousand yuan） was significantly higher for dHVHF group （15. 00± 2.80 vs. 9.85 ±3.00, P〈0.01）. Conclusion For patients with post-cardiac surgery AKI, GDRRT and dHVHF are very similar in terms of short-terra survival rate and safety. But GDRRT is superior for renal function recovery and cost saving.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2011年第12期749-754,共6页
Chinese Critical Care Medicine
基金
上海市重大课题（08dz1900602）
教育部国家“211工程”重点学科建设项目（211XK20）
上海市医学发展基金重点研究课题（2003ZD001）
关键词
心脏手术
肾损伤
急性
目标导向肾脏替代治疗
高容量血液滤过
Cardiac surgery
Acute kidney injury
Goal-directed renal replacement therapy
High volum hemofiltration
