连续肾脏替代治疗在肝移植围手术期的应用

Perioperative continuous renal replacement therapy(CRRT) in patients undergoing orthotopic liver transplantation

目的探讨连续肾脏替代治疗(continuousrenalreplacementtherapy,CRRT)对肝移植围手术期患者肾功能衰竭的预防作用。方法回顾性分析21例肝移植围手术期应用CRRT的患者的肾功能情况。结果所有行CRRT的患者血清肌酐值均有不同程度下降,21例患者中存活13例,死亡8例(38.1%)。其中有12例患者肾功能恢复,9例患者肾功能未恢复。肾功能恢复患者死亡率8.3%,未恢复患者死亡率77.8%,两者相比差异有统计学意义(χ2=5.838,P<0.05)。治疗期间无严重的并发症。结论CRRT是肝移植术后患者的肾脏替代治疗的首选,尽管如此在围手术期应用CRRT治疗的患者仍有较高的死亡率。

Objective To analyze the role of continuous renal replacement therapy(CRRT) in the prevention of renal failure in perioperative patients undergoing orthotopic liver transplantation. Methods The clinical data of renal function were reviewed in 21 liver transplantation patients receiving CRRT during perioperative period. Results Serum Cr level decreased after CRRT in all 21 patients; The overall mortality in this group was 38.1%. The mortality rate was 8.3% in the 12 cases in whom the renal function recovered, and that was 77.8% in the 9 cases in whom the renal function did not recover (χ~2=5.838,P<0.05). The CRRT itself did not bring about severe complications. Conclusion CRRT is the therapy of choice for acute renal failure in patients of liver transplantation during perioperative period, though the mortality was high.