CAJ | 학술논문

目的：：对比性研究连续性肾替代及自动腹膜透析治疗心脏术后急性肾损伤的治疗效果。方法：筛选于2013年7月~2015年3月期间在海南省农垦总医院及海口市人民医院行心脏手术,术后并发急性肾损伤符合条件的患者80例,40例患者实施自动化腹膜透析,根据透析剂量分为150 ml · kg-1· d-1( A1组)20例和300 ml · kg-1· d-1( A2组)20例,40例患者实施连续性肾替代疗法,根据透析剂量分为25 ml·kg-1·h-1(C1组)20例和40 ml·kg-1·h-1(C2组)20例,记录透析前、治疗(12 h、24 h、48 h、72 h)后,患者血BUN、Scr、钾离子(K+)浓度,记录各组治疗效果及不良事件发生情况。结果：A1、A2、C1及C2组治疗后血 BUN、Scr及血 K+各时间点均有不同程度的降低,其中在72 h 时降低显著( P <0.01)；各组30 d存活率差异无统计学意义,A2组较A1组在肾功能完全恢复率、肾功能完全恢复所需时间、肾功能总恢复率及少尿缓解所需时间上差异均具有统计学意义(P<0.05或P<0.01)；C2组较C1组肾功能完全恢复所需时间及少尿缓解所需时间上差异均具有统计学意义(P<0.05或P<0.01)；C1较A1,C2较A2少尿缓解所需时间长,差异有统计学意义(P<0.01)；A2较A1组、C2较C1组心动过速发生率高,C2组较C1组、A2组低血压发生率高,差异有统计学意义(P<0.05)；在凝血发生率方面,各组差异无统计学意义。结论：两种方法治疗心脏术后急性肾损伤大剂量治疗效果较好,但不良事件发生率大剂量较高,APD在不良时间发生率及少尿缓解上优势明显。
목적：：대비성연구련속성신체대급자동복막투석치료심장술후급성신손상적치료효과。방법：사선우2013년7월~2015년3월기간재해남성농은총의원급해구시인민의원행심장수술,술후병발급성신손상부합조건적환자80례,40례환자실시자동화복막투석,근거투석제량분위150 ml · kg-1· d-1( A1조)20례화300 ml · kg-1· d-1( A2조)20례,40례환자실시련속성신체대요법,근거투석제량분위25 ml·kg-1·h-1(C1조)20례화40 ml·kg-1·h-1(C2조)20례,기록투석전、치료(12 h、24 h、48 h、72 h)후,환자혈BUN、Scr、갑리자(K+)농도,기록각조치료효과급불량사건발생정황。결과：A1、A2、C1급C2조치료후혈 BUN、Scr급혈 K+각시간점균유불동정도적강저,기중재72 h 시강저현저( P <0.01)；각조30 d존활솔차이무통계학의의,A2조교A1조재신공능완전회복솔、신공능완전회복소수시간、신공능총회복솔급소뇨완해소수시간상차이균구유통계학의의(P<0.05혹P<0.01)；C2조교C1조신공능완전회복소수시간급소뇨완해소수시간상차이균구유통계학의의(P<0.05혹P<0.01)；C1교A1,C2교A2소뇨완해소수시간장,차이유통계학의의(P<0.01)；A2교A1조、C2교C1조심동과속발생솔고,C2조교C1조、A2조저혈압발생솔고,차이유통계학의의(P<0.05)；재응혈발생솔방면,각조차이무통계학의의。결론：량충방법치료심장술후급성신손상대제량치료효과교호,단불량사건발생솔대제량교고,APD재불량시간발생솔급소뇨완해상우세명현。
Objective:To contrastive study of continuous renal replacement therapy and automated peritoneal dialysis on the treatment of acute kidney injury after cardiac surgery treatment. Methods:Screening 80 patients with acute kidney injury after cardiac surgery treatment in Hainan provincial general hospital and haikou hospital during 2013. 7-2015. 3, 40patients implementation of au-tomated peritoneal dialysis, 150 ml·kg-1·d-1(A1 group) 20 cases and 300ml·kg-1·d-1(A2 group) 20cases according to dial-ysis dose, 40cases with continuous renal replacement therapy, 25ml·kg-1 ·h-1 ( C1 group) 20 cases and 40ml·kg-1 ·h-1 ( C2 group) 20 cases according to the dialysis dose. Patients were recorded the serum BUN, Scr, K+ concentration before and after dialy-sis treatment (12 h, 24 h, 48 h, 72 h), the occurrence of adverse events in each treatment group. Results:Serum BUN, Scr and K+were decreased in different degree in A1, A2, C1 and C2 group at different time point after treatment, and significantly reduced at 72 h (P<0. 01);difference of 30 d survival in each group was not statistically significant; differences were statistically significant between A2 group and A1 group in full recovery rate of renal function, time required for full recovery of renal function, renal function overall recovery rate and time required for oliguria ease (P<0. 05 or P<0. 01);differences were statistically significant between C2 group and C1 group in time required for full recovery of renal function for oliguria ease (P<0. 05 or P<0. 01);time required to alle-viate oliguria was longer in C1 than A1 group, C2 than A2 group and the difference was significant (P<0. 01);there was higher inci-dence of tachycardia in A2 than A1 group, C2 than C1 group, higher incidence of hypotension rate in C2 group than C1 and A2 group, the differences were statistically significant (P<0. 05 );on the incidence of blood clotting, there was no statistically signifi-cant difference in each group. Conclusion:Large dose treatments in the two methods on treatment of acute kidney injury after cardiac surgery were better, but with higher incidence of adverse events, moreover APD had obvious advantages on the incidence of adverse and oliguria alleviate time.