中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2011年
12期
749-754
,共6页
许佳瑞%滕杰%邹建洲%方艺%沈波%刘中华%王春生%杨守国%陈昊%丁小强
許佳瑞%滕傑%鄒建洲%方藝%瀋波%劉中華%王春生%楊守國%陳昊%丁小彊
허가서%등걸%추건주%방예%침파%류중화%왕춘생%양수국%진호%정소강
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
心髒手術%腎損傷,急性%目標導嚮腎髒替代治療%高容量血液濾過
심장수술%신손상,급성%목표도향신장체대치료%고용량혈액려과
Cardiac surgery%Acute kidney injury%Goal-directed renal replacement therapy%High volum hemofiltration
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％；28 d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=0.042].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(μmol/L:最高值559.0±236.0比440.4±192.0,出院值381.4±267.0比271.2±164.4,均P＜0.01).RRT治疗72 h内GDRRT组和dHVHF组低血压发生率、平均动脉压(mm Hg,1 mm Hg=0.133 kPa)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.
目的 比較目標導嚮腎髒替代療法(GDRRT)與每日高容量血液濾過(dHVHF)治療心髒手術後急性腎損傷(AKI)的療效及其安全性.方法 迴顧性分析2002年1月至2010年9月128例心髒手術後髮生AKI,併接受腎髒替代治療(RRT)患者的臨床資料,比較GDRRT與dHVHF後的臨床轉歸和不良事件髮生率等.結果 GDRRT組(64例)和dHVHF組(64例)患者院內病死率均為43.75％；28 d病死率GDRRT組略低,但差異無統計學意義(43.75％比57.81％,P=0.055),dHVHF組住重癥鑑護病房(ICU)時間(h)和機械通氣時間(d)均明顯長于GDRRT組[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=0.042].兩組住院時間無明顯差異.採用logistic多因素迴歸分析校正混雜因素後,GDRRT組腎功能完全恢複率顯著高于dHVHF組(39.1％比18.8％,P＜0.01)；腎功能部分恢複率低于dHVHF組,但差異無統計學意義(3.1％比9.4％,P＞0.05).dHVHF組RRT治療期間血肌酐(SCr)最高值及齣院時SCr值均顯著高于GDRRT組(μmol/L:最高值559.0±236.0比440.4±192.0,齣院值381.4±267.0比271.2±164.4,均P＜0.01).RRT治療72 h內GDRRT組和dHVHF組低血壓髮生率、平均動脈壓(mm Hg,1 mm Hg=0.133 kPa)差異無統計學意義(35.9％比37.5％,82±13比81±15,均P＞0.05)；dHVHF組心動過速及凝血事件髮生率高于GDRRT組(78.1％比59.4％,35.9％比20.3％,均P＜0.05).dHVHF組住院期間治療費用(萬元)明顯高于GDRRT組(1.500±0.280比0.985±0.300,P＜0.01).結論 GDRRT治療心髒術後AKI安全有效,短期生存率及安全性與dHVHF相近,而在改善腎髒預後方麵的作用 及降低治療費用均優于dHVHF.
목적 비교목표도향신장체대요법(GDRRT)여매일고용량혈액려과(dHVHF)치료심장수술후급성신손상(AKI)적료효급기안전성.방법 회고성분석2002년1월지2010년9월128례심장수술후발생AKI,병접수신장체대치료(RRT)환자적림상자료,비교GDRRT여dHVHF후적림상전귀화불량사건발생솔등.결과 GDRRT조(64례)화dHVHF조(64례)환자원내병사솔균위43.75％；28 d병사솔GDRRT조략저,단차이무통계학의의(43.75％비57.81％,P=0.055),dHVHF조주중증감호병방(ICU)시간(h)화궤계통기시간(d)균명현장우GDRRT조[356.5(176.3,554.6)비238.3(119.6,440.9),P=0.023;8.0(5.0,16.0)비6.0(3.0,13.5),P=0.042].량조주원시간무명현차이.채용logistic다인소회귀분석교정혼잡인소후,GDRRT조신공능완전회복솔현저고우dHVHF조(39.1％비18.8％,P＜0.01)；신공능부분회복솔저우dHVHF조,단차이무통계학의의(3.1％비9.4％,P＞0.05).dHVHF조RRT치료기간혈기항(SCr)최고치급출원시SCr치균현저고우GDRRT조(μmol/L:최고치559.0±236.0비440.4±192.0,출원치381.4±267.0비271.2±164.4,균P＜0.01).RRT치료72 h내GDRRT조화dHVHF조저혈압발생솔、평균동맥압(mm Hg,1 mm Hg=0.133 kPa)차이무통계학의의(35.9％비37.5％,82±13비81±15,균P＞0.05)；dHVHF조심동과속급응혈사건발생솔고우GDRRT조(78.1％비59.4％,35.9％비20.3％,균P＜0.05).dHVHF조주원기간치료비용(만원)명현고우GDRRT조(1.500±0.280비0.985±0.300,P＜0.01).결론 GDRRT치료심장술후AKI안전유효,단기생존솔급안전성여dHVHF상근,이재개선신장예후방면적작용 급강저치료비용균우우dHVHF.
Objective To compare the efficacy 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 cardiac surgery were analyzed retrospectively.Parameters examined included:urea nitrogen,serum creatinine(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 function recovery rate,and the incidence 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 care unit(ICU)stay(hours)and duration of mechanical ventilation(days)as compared to the patients received 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=0.042].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 significantly higher than GDRRT group(μmol/L:SCr maximun 559.0± 236.0 vs.440.4± 192.0,SCr before discharge 381.4± 267.0 vs.271.2± 164.4,both P＜0.01).No significant difference was found between the two groups in incidence 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-term survival rate and safety.But GDRRT is superior for renal function recovery and cost saving.
