中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
14期
1-3,38
,共4页
季艳梅%张浩明%方敏%陈森%郭家龙
季豔梅%張浩明%方敏%陳森%郭傢龍
계염매%장호명%방민%진삼%곽가룡
心脏病%老年人%急性肾损伤%法舒地尔
心髒病%老年人%急性腎損傷%法舒地爾
심장병%노년인%급성신손상%법서지이
Heart diseases%Aged%Acute kidney injury%Fasudil
目的 观察血液净化联合法舒地尔治疗老年心脏术后急性肾损伤的临床效果.方法 50例老年心脏术后急性肾损伤患者,按随机数字表法分为对照组和研究组,每组25例.均予常规药物治疗及血液净化,研究组在常规药物治疗及血液净化的同时给予法舒地尔注射液30 mg+0.9％氯化钠注射液50 ml静脉泵入,每12h1次,连用7d.观察治疗前后两组患者尿量、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿γ-谷氨酰转移酶(γ-GTP)、尿α1-微球蛋白(α1-MG)、血清肌酐(SCr)、血尿素氮(BUN)及肌酐清除率(CCr)的变化,并计算两组患者急性生理学和慢性健康评估(APACHE)Ⅱ评分.结果 两组治疗前各项指标比较差异均无统计学意义(P＞0.05).研究组治疗后3,5,7d尿量明显多于同期对照组[(38.72±2.68) ml/h比(31.68±2.52) ml/h、(47.24±3.73) ml/h比(40.24±2.52) ml/h、(63.80±2.50) ml/h比(56.60±3.30) ml/h],尿NAG、尿α1-MG、尿γ-GTP、SCr、BUN均明显低于同期对照组[尿NAG:(25.05±5.44) U/L比(28.04±5.21) U/L、(24.06±3.43) U/L比(27.23±6.43) U/L、(22.08±3.25) U/L比(26.23±4.41) U/L;尿α1-MG:(24.05±3.65) mg/L比(26.74±6.74) mg/L、(22.98±3.58) mg/L比(25.57±3.58) mg/L、(20.95±3.78) mg/L比(25.48±3.45) mg/L;尿γ-GTP:(8.2±0.4) U/L比(10.8±3.8) U/L、(7.3±0.2) U/L比(10.5±2.5) U/L、(6.5±1.4) U/L比(9.7±2.6) U/L;SCr:(206.52±6.72)μmol/L比(255.16±6.75)μmol/L、(182.98±6.26)μmol/L比(252.23±9.53)μmol/L,(133.25±7.95)μmol/L比(170.75±7.94)μmol/L;BUN:(19.61±3.23) mmol/L比(20.25±3.25) mmol/L、(16.76±2.06) mmol/L比(18.32±4.84) mmol/L、(12.28±2.26) mmol/L比(14.27±4.54) mmol/L],CCr明显高于同期对照组[(18.66±3.89) ml/min比(13.28±3.25) ml/min、(27.76±4.36) ml/min比(16.23±4.18) ml/min、(33.79±5.58) ml/min比(22.12±4.65) ml/min],差异均有统计学意义(P＜0.05).对照组治疗前及治疗后5,7d APACHEⅡ评分分别为(32.20±4.51)、(26.38±5.28)、(21.43±4.22)分,研究组分别为(33.05±3.82)、(22.15±3.42)、(13.25±2.15)分.两组治疗前APACHEⅡ评分比较差异无统计学意义(P＞0.05),两组治疗后5,7 d APACHEⅡ评分均得到了显著改善,而且研究组显著优于对照组,差异有统计学意义(P＜0.05).结论 采用血液净化联合法舒地尔治疗老年心脏术后急性肾损伤患者临床效果显著,同时安全性高,具有十分重要临床意义.
目的 觀察血液淨化聯閤法舒地爾治療老年心髒術後急性腎損傷的臨床效果.方法 50例老年心髒術後急性腎損傷患者,按隨機數字錶法分為對照組和研究組,每組25例.均予常規藥物治療及血液淨化,研究組在常規藥物治療及血液淨化的同時給予法舒地爾註射液30 mg+0.9％氯化鈉註射液50 ml靜脈泵入,每12h1次,連用7d.觀察治療前後兩組患者尿量、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿γ-穀氨酰轉移酶(γ-GTP)、尿α1-微毬蛋白(α1-MG)、血清肌酐(SCr)、血尿素氮(BUN)及肌酐清除率(CCr)的變化,併計算兩組患者急性生理學和慢性健康評估(APACHE)Ⅱ評分.結果 兩組治療前各項指標比較差異均無統計學意義(P＞0.05).研究組治療後3,5,7d尿量明顯多于同期對照組[(38.72±2.68) ml/h比(31.68±2.52) ml/h、(47.24±3.73) ml/h比(40.24±2.52) ml/h、(63.80±2.50) ml/h比(56.60±3.30) ml/h],尿NAG、尿α1-MG、尿γ-GTP、SCr、BUN均明顯低于同期對照組[尿NAG:(25.05±5.44) U/L比(28.04±5.21) U/L、(24.06±3.43) U/L比(27.23±6.43) U/L、(22.08±3.25) U/L比(26.23±4.41) U/L;尿α1-MG:(24.05±3.65) mg/L比(26.74±6.74) mg/L、(22.98±3.58) mg/L比(25.57±3.58) mg/L、(20.95±3.78) mg/L比(25.48±3.45) mg/L;尿γ-GTP:(8.2±0.4) U/L比(10.8±3.8) U/L、(7.3±0.2) U/L比(10.5±2.5) U/L、(6.5±1.4) U/L比(9.7±2.6) U/L;SCr:(206.52±6.72)μmol/L比(255.16±6.75)μmol/L、(182.98±6.26)μmol/L比(252.23±9.53)μmol/L,(133.25±7.95)μmol/L比(170.75±7.94)μmol/L;BUN:(19.61±3.23) mmol/L比(20.25±3.25) mmol/L、(16.76±2.06) mmol/L比(18.32±4.84) mmol/L、(12.28±2.26) mmol/L比(14.27±4.54) mmol/L],CCr明顯高于同期對照組[(18.66±3.89) ml/min比(13.28±3.25) ml/min、(27.76±4.36) ml/min比(16.23±4.18) ml/min、(33.79±5.58) ml/min比(22.12±4.65) ml/min],差異均有統計學意義(P＜0.05).對照組治療前及治療後5,7d APACHEⅡ評分分彆為(32.20±4.51)、(26.38±5.28)、(21.43±4.22)分,研究組分彆為(33.05±3.82)、(22.15±3.42)、(13.25±2.15)分.兩組治療前APACHEⅡ評分比較差異無統計學意義(P＞0.05),兩組治療後5,7 d APACHEⅡ評分均得到瞭顯著改善,而且研究組顯著優于對照組,差異有統計學意義(P＜0.05).結論 採用血液淨化聯閤法舒地爾治療老年心髒術後急性腎損傷患者臨床效果顯著,同時安全性高,具有十分重要臨床意義.
목적 관찰혈액정화연합법서지이치료노년심장술후급성신손상적림상효과.방법 50례노년심장술후급성신손상환자,안수궤수자표법분위대조조화연구조,매조25례.균여상규약물치료급혈액정화,연구조재상규약물치료급혈액정화적동시급여법서지이주사액30 mg+0.9％록화납주사액50 ml정맥빙입,매12h1차,련용7d.관찰치료전후량조환자뇨량、뇨N-을선-β-D-안기포도당감매(NAG)、뇨γ-곡안선전이매(γ-GTP)、뇨α1-미구단백(α1-MG)、혈청기항(SCr)、혈뇨소담(BUN)급기항청제솔(CCr)적변화,병계산량조환자급성생이학화만성건강평고(APACHE)Ⅱ평분.결과 량조치료전각항지표비교차이균무통계학의의(P＞0.05).연구조치료후3,5,7d뇨량명현다우동기대조조[(38.72±2.68) ml/h비(31.68±2.52) ml/h、(47.24±3.73) ml/h비(40.24±2.52) ml/h、(63.80±2.50) ml/h비(56.60±3.30) ml/h],뇨NAG、뇨α1-MG、뇨γ-GTP、SCr、BUN균명현저우동기대조조[뇨NAG:(25.05±5.44) U/L비(28.04±5.21) U/L、(24.06±3.43) U/L비(27.23±6.43) U/L、(22.08±3.25) U/L비(26.23±4.41) U/L;뇨α1-MG:(24.05±3.65) mg/L비(26.74±6.74) mg/L、(22.98±3.58) mg/L비(25.57±3.58) mg/L、(20.95±3.78) mg/L비(25.48±3.45) mg/L;뇨γ-GTP:(8.2±0.4) U/L비(10.8±3.8) U/L、(7.3±0.2) U/L비(10.5±2.5) U/L、(6.5±1.4) U/L비(9.7±2.6) U/L;SCr:(206.52±6.72)μmol/L비(255.16±6.75)μmol/L、(182.98±6.26)μmol/L비(252.23±9.53)μmol/L,(133.25±7.95)μmol/L비(170.75±7.94)μmol/L;BUN:(19.61±3.23) mmol/L비(20.25±3.25) mmol/L、(16.76±2.06) mmol/L비(18.32±4.84) mmol/L、(12.28±2.26) mmol/L비(14.27±4.54) mmol/L],CCr명현고우동기대조조[(18.66±3.89) ml/min비(13.28±3.25) ml/min、(27.76±4.36) ml/min비(16.23±4.18) ml/min、(33.79±5.58) ml/min비(22.12±4.65) ml/min],차이균유통계학의의(P＜0.05).대조조치료전급치료후5,7d APACHEⅡ평분분별위(32.20±4.51)、(26.38±5.28)、(21.43±4.22)분,연구조분별위(33.05±3.82)、(22.15±3.42)、(13.25±2.15)분.량조치료전APACHEⅡ평분비교차이무통계학의의(P＞0.05),량조치료후5,7 d APACHEⅡ평분균득도료현저개선,이차연구조현저우우대조조,차이유통계학의의(P＜0.05).결론 채용혈액정화연합법서지이치료노년심장술후급성신손상환자림상효과현저,동시안전성고,구유십분중요림상의의.
Objective To explore the clinical effect of blood purification combined with fasudil in elderly cardiac surgery patients with postoperative acute kidney injury.Methods Fifty elderly cardiac surgery patients with postoperative acute kidney injury were divided into control group and study group by random digit table method with 25 cases each.The 2 groups were treated with routine drug and blood purification,the study group was additionally given fasudil injection 30 mg + 0.9％ sodium chloride injection 50 ml vein pumping,1 time/12 h,for 7 d.The urine volume,urine N-acetyl-β-D-glucosaminidase (NAG),urine γ-glutamyl transpeptidase (γ-GTP),urine α 1-microglobulin (α 1-MG),serum creatinine (SCr),blood urea nitrogen (BUN) and creatinine clearance rate (CCr) were observed,and the acute physiology and chronic health evaluation (APACHE) Ⅱ score was computed.Results There were no statistical differences in the indexes before treatment between the 2 groups (P＞ 0.05).The urine volume after treatment 3,5,7 d in study group was more than that in control group [(38.72 ± 2.68) ml/h vs.(31.68 ± 2.52) ml/h,(47.24 ±3.73) ml/h vs.(40.24 ± 2.52) ml/h、(63.80 ± 2.50) ml/h vs.(56.60 ± 3.30) ml/h],urine NAG,urine α 1-MG,urine γ-GTP,SCr and BUN were lower than those in control group [NAG:(25.05 ±5.44) U/L vs.(28.04 ± 5.21) U/L,(24.06 ± 3.43) U/L vs.(27.23 ± 6.43) U/L,(22.08 ± 3.25) U/L vs.(26.23 ± 4.41) U/L; α 1-MG:(24.05 ± 3.65) mg/L vs.(26.74 ± 6.74) mg/L,(22.98 ± 3.58) mg/L vs.(25.57 ± 3.58) mg/L,(20.95 ± 3.78) mg/L vs.(25.48 ± 3.45) mg/L; γ-GTP:(8.2 ± 0.4) U/L vs.(10.8 ± 3.8) U/L,(7.3 ± 0.2)U/L vs.(10.5 ± 2.5) U/L,(6.5 ± 1.4) U/L vs.(9.7 ± 2.6) U/L; SCr:(206.52 ± 6.72) μ mol/L vs.(255.16 ±6.75) μmol/L,(182.98 ±6.26) μmol/L vs.(252.23 ±9.53) μmol/L,(33.25 ±7.95) μmol/L vs.(170.75 ± 7.94) μ mol/L; BU N:(19.61 ± 3.23) mmol/L vs.(20.25 ± 3.25) mmol/L,(16.76 ± 2.06) mmol/L vs.(18.32 ± 4.84) mmol/L,(12.28 ± 2.26) mmol/L vs.(14.27 ± 4.54) mmol/L],CCr was higher than that in control group [(18.66 ± 3.89) ml/min vs.(13.28 ± 3.25) ml/min,(27.76 ± 4.36) ml/min vs.(16.23 ± 4.18)ml/min,(33.79 ± 5.58) ml/min vs.(22.12 ± 4.65) ml/min],there were statistical differences (P ＜ 0.05).The APACHE Ⅱ score before treatment and after treatment 5,7 d in control group were (32.20 ±4.51),(26.38 ±5.28) and (21.43 ±4.22) scores,in study group were (33.05 ±3.82),(22.15 ±3.42) and (13.25 ± 2.15) scores.There was no statistical difference in the APACHE Ⅱ score before treatment (P ＞ 0.05),the APACHE Ⅱ score after treatment was improved,furthermore APACHE Ⅱ score after treatment 5,7 d in study group were better than those in control group,there were statistical differences (P ＜ 0.05).Conclusions The treatment effect of blood purification combined with fasudil is remarkable in elderly cardiac surgery patients with postoperative acute kidney injury.At the same time,it has high security and very important clinical significance.
