不同血液净化方式治疗心脏术后急性肾损伤对比观察

Clinical effects for the patients with acute kidney injury after heart surgery by different blood purification way

目的探讨连续性血液净化（CBP）与腹膜透析（PD）治疗心脏手术后并发急性肾损伤（acutekidneyinjury，AKI）的临床疗效差异。方法选取本院收治的82例心脏手术后并发急性肾损伤，采用血液净化方式治疗的患者临床资料，根据采取的净化方式分为CBP组42例、APD组40例，对两组患者的临床治疗结局、治疗后存活患者的相关指标进行比较。结果CBP组经过治疗存活28例、死亡13例，存活率为66．67％，APD组患者存活24例、死亡16例，存活率为60％，两组患者的存活率比较差异无统计学意义（）（2=0．249，P=0．618）。治疗后两组存活患者的APACHE1I评分较治疗前均显著降低[CBP组：（21．2±8．4）分与（12．6±4．6）分；PD组（20．8±7．9）分与（15．3±4．4）分，P均〈0．05]，CBP组降低更加显著（P〈0．05）。治疗后两组存活患者的血尿素氮（BUN）、血肌酐（SCr）、左室射血分数（LVEF）、心脏指数（CI）、心脏输出量（co）较治疗前均显著好转（P〈0．05），CBP组优于PD组（P〈0．05）。治疗后两组存活患者的天冬氨酸氨基转移酶（AST）、乳酸脱氢酶（LDH）、血乳酸（Lac）较治疗前均显著好转（P〈0．05）。结论连续性血液净化较腹膜透析治疗心脏手术后并发急性肾损伤对患者的近期结局影响不显著，但是可以较好地改善患者的心肾功能，减轻炎症反应。

Objective To explore the clinical effects for the patients with acute kidney injury after heart surgery by different blood purification way. Methods 82 cases of patients with acute kidney injury after heart surgery were divided into CBP group and APD group, the clinical outcome, index of correlation were compared. Results CBP group with 28 cases survive, 13 cases death, survival rate was 66.67% ; APD group with 24 cases survive, 16 eases death, survival rate was 60% ; there was no significant difference on the survival rate （X2 = 0. 249, P = 0. 618 ）. The scores of APACHE 11 after treatment were lower than before treatment（P 〈0.05）, the levels of BUN, Scr, LVEF, CI, CO for the CBP group were better than the PD group（P 〈 0. 05）. The levels of AST, LDH, Lae after treatment were better than before treatment（P 〈 0.05 ）. Conclusion It has good clinical effects for the patients with acute kidney injury after heart surgery by continuous blood purification, it can improve the heart - kidney function, reduce the inflammatory reaction.