连续性肾脏替代治疗在重症心脏瓣膜病术后急性肾功能衰竭的临床应用

Clinical application of continuous renal replacement therapy for postoperative renal insufficiency in patient with severe heart valve disease

目的探讨连续性肾脏替代治疗(CRRT)在心脏瓣膜病术后出现急性肾功能衰竭的临床应用价值。方法回顾性分析心脏瓣膜病术后合并急性肾功能衰竭行CRRT治疗的27例患者(存活组15例,死亡组12例)的临床资料,并进行统计分析。结果死亡组CRRT距AKI时间和距尿量<0.5ml/Kg.h时间明显长于存活组(P<0.05),且死亡组CRRT开始前的血肌酐显著高于存活组(P<0.05)。27例患者CRRT治疗前后血肌酐、尿素氮、平均动脉压、中心静脉压、血K+、血HCO3-差异有统计学意义(P<0.05)。结论 CRRT是心脏瓣膜病术后发生AKI的有效治疗手段。但必须强调早期AKI诊断和及时CRRT治疗,对改善患者的预后有积极作用。

Objectives To evaluate clinical application the ot connnuous renal postoperative renal insufficiency in patient with severe heart valve disease. Methods We retrospectively analyzed the clinical data of 27 patients （live group 15 cases, death group 12 cases） with severe heart valves diseases who got postoperative renal insufficiency arid performed CRRT. Results Gender, age, the classification of preoperative heart function classification and extracorporeal circulation time has no significant difference （P〈0.05） between live group and death group. But the duration of AKI before CRRT（P〈0.05）and the time of urine volume〈0. 5ml· kg-1 · h-1 before CRRT （P〈0.05） in death group were significantly longer than that in live group. The serum creafinine of death group before CRRT is also significantly higher than live group （P〈0. 05）. The serum creatinine, blood urea nitrogen, mean arterial pressure, central venous blood pressure, K＋ and blood HCO3- of all 27 patients after CRRT are statistically significant difference （P^0.05） with those before CRRT. Conclusion CRRT is an important treatment to these patients with severe heart valve disease who got postoperative renal insufficiency. But the most important problem in this process is the recognition of AKI and early beginning of the therapy. It is suggested that early CRRT therapy is beneficial for reducing mortality rate of these patients.