中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (02): 86-90.doi: 10.3969/j.issn.1671-4091.2017.02.005

• 临床研究 • 上一篇    下一篇

连续性肾脏替代治疗剂量对心脏手术相关急性肾损伤预后的影响

梁华般1,宋利1,董伟1,符霞1,全梓林1,李志莲1,李锐钊1,刘双信1,史伟1,梁馨苓1   

  1. 1. 广东省医学科学院广东省人民医院肾内科
  • 收稿日期:2016-06-29 修回日期:2016-12-07 出版日期:2017-02-12 发布日期:2017-02-12
  • 通讯作者: 梁馨苓 xinlingliang@139.com E-mail:13808829770@139.com
  • 基金资助:

    国家临床重点专科建设项目“十二五”国家科技支撑计划项目(2011BAI10B08)广东省自然科学基金(2014A03031345)

The intensity of continuous renal replacement therapy on the prognosis of cardiac surgery related acute kidney injury patients

  • Received:2016-06-29 Revised:2016-12-07 Online:2017-02-12 Published:2017-02-12

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摘要： 目的探讨连续性血液净化不同剂量对心脏手术相关急性肾损伤(cardiac surgery associated acute kidney injury, CSA-AKI)患者预后的影响。方法2013 年11 月～2016 年2 月在广东省人民医院就诊的符合纳入和排除标准的患者共151 例，随机分为两组：高剂量组35ml/(kg.h)78 例，低剂量组25 ml/(kg•h)73 例，观察终点为随机分组后14 天、28 天、90 天的全因死亡率及肾脏的恢复情况。结果ITT 分析及Kaplan-Meier 生存分析结果显示，高剂量组和低剂量组的患者14 天(63.4%比
65.7% ，χ2=0.591，P=0.442)、28 天(54.5% 比55.6% ，χ2=1.232，P=0.267) 以及90 天(45.5% 比47.5% ，χ2=2.810，P=0.094)生存率均无显著性差异。CRRT 治疗不同剂量对14 天(14.3%比10.1%，χ2=2.011,P=0.570)、28 天(22.3%比18.2%，χ2=1.524,P=0.674)、90 天(25.0%比18.4%，χ2=4.560, P=0.207)存活的CSAAKI患者肾功能恢复情况的影响无显著性差异。结论CRRT 治疗不同剂量25ml/(kg•h)与35ml/(kg•h)对CSA-AKI患者的临床预后无明显差别，包括14 天、28 天、90天患者死亡率和肾脏功能恢复。

关键词: 连续性肾脏替代治疗, 心脏手术相关急性肾损伤, 剂量, 存活率

Abstract: Objective Acute kidney injury (AKI) is a major complication after cardiac surgery and is an independent risk factor for mortality. However, the optimal intensity of renal replacement therapy for these patients is still controversial. Methods We recruited 151 AKI patients after cardiac surgery and treated with continuous renal replacement therapy (CRRT) during the period from Nov. 2013 to Feb. 2016 and assigned them into 2 groups based on the intensity of CRRT, the high intensity group [35(ml/kg•h), n=78) and the low intensity group [25(ml/kg • h)], n=73). The endpoints of observation were the all- cause mortality within 14, 28 and 90 days and the renal function at the 14th, 28th and 90th days after being grouped. Kaplan- Meier survival curve was used for the analyses. Results The two groups had similar baseline characteristics. There were no significant differences between the two groups in number of death within 14, 28 and 90 days. In high intensity group and low intensity group, the survival rates within 14 days were 63.4% (49/78) and 65.7% (48/73) (χ2=0.591, P=0.442) respectively, the rates within 28 days were 54.5% (43/78) and 55.6% (41/73) (χ2=1.232, P=0.267) respectively, and the rates within 90 days were 45.5% (35/78) and 47.5% (35/73) (χ2=4.560, P=0.094) respectively. The recovery of renal function in survival patients also had no differences between the 2 groups at the 14th, 28th and 90th days. Conclusions In patients with AKI after cardiac surgery, the CRRT intensity of 25 ml/kg/h and 35 ml/kg/h had no differences in mortality within 14, 28 and 90 days and in recovery of renal function in survival patients at the 14th, 28th and 90th days.

Key words: Continuous renal replacement therapy, Cardiac surgery associated acute kidney injury, Intensity, Survival