CAJ | 학술논문

目的：探讨床旁床旁连续性肾脏替代治疗（CRRT）在心外科术后急性肾衰患者中的应用。方法：回顾性分析2012年11月-2014年11月在本院心外科行心脏手术后发生急性肾衰的30例患者的临床资料，所选患者均在常规治疗的基础上给予CRRT，观察所有患者的治疗效果以及治疗前后的心、肾功能。结果：所有30例患者中，存活26例，其中痊愈23例，有效3例，死亡4例，治疗总有效率为86.67%；CRRT在术后2~24 h内应用，连续应用在24 h以上，平均（68.7±6.2）h；治疗后心排血指数（CI）、心率（HR）、平均动脉压（MAP）、肺毛细血管楔压（PCWP）、中心静脉压（CVP）、血氧饱和度（SpO2）、左室射血分数（LVEF）、氧合指数（PaO2/FiO2）、尿素氮（BUN）、肌酐（Cr）、血HCO3-、血钾、尿量均优于治疗前，比较差异有统计学意义（P<0.05）。结论：心外科术后急性肾衰患者早期行床旁CRRT治疗能够有效减少死亡率，改善心功能及肾功能，疗效显著，具有积极的临床意义。
목적：탐토상방상방련속성신장체대치료（CRRT）재심외과술후급성신쇠환자중적응용。방법：회고성분석2012년11월-2014년11월재본원심외과행심장수술후발생급성신쇠적30례환자적림상자료，소선환자균재상규치료적기출상급여CRRT，관찰소유환자적치료효과이급치료전후적심、신공능。결과：소유30례환자중，존활26례，기중전유23례，유효3례，사망4례，치료총유효솔위86.67%；CRRT재술후2~24 h내응용，련속응용재24 h이상，평균（68.7±6.2）h；치료후심배혈지수（CI）、심솔（HR）、평균동맥압（MAP）、폐모세혈관설압（PCWP）、중심정맥압（CVP）、혈양포화도（SpO2）、좌실사혈분수（LVEF）、양합지수（PaO2/FiO2）、뇨소담（BUN）、기항（Cr）、혈HCO3-、혈갑、뇨량균우우치료전，비교차이유통계학의의（P<0.05）。결론：심외과술후급성신쇠환자조기행상방CRRT치료능구유효감소사망솔，개선심공능급신공능，료효현저，구유적겁적림상의의。
Objective:To study the application of bedside continuous renal replacement therapy(CRRT)in acute renal failure after cardiac surgery.Method:The clinical data of 30 patients who occurred acute renal failure after cardiac surgery in our hospital from November 2012 to November 2014 were retrospectively analyzed.All patients were given bedside CRRT on the basis of routine treatment.The treatment results,the cardiac function and the renal function before and after the treatment were observed.Result:Among the 30 patients,26 cases survived and 4 cases died.In the 26 survival patients,23 patients were recovery and 3 patients were effective.The total effective rate was 86.67%.CRRT was applied in 2 to 24 hours after the operation,it was continuously applied for more than 24 hours,the mean time was (68.7±6.2)hours.The cardiac index(CI),heart rate(HR),mean arterial pressure(MAP),pulmonary capillary wedge pressure(PCWP),central venous pressure(CVP),oxygen saturation(SpO2),left ventricular ejection fraction (LVEF),oxygenation index(PaO2/FiO2),blood urea nitrogen(BUN),creatinine(Cr),HCO3-in blood,serum potassium and urine volume after treatment were better than before treatment,the differences were statistically significant (P<0.05).Conclusion:Bedside CRRT in patients with acute renal failure after cardiac surgery can effectively reduce the mortality rate and improve heart function and renal function.The curative effect of the treatment is remarkable and it has positive clinical significance.