急性肾损伤97例非肾脏替代治疗临床体会

Clinical experience in 97 cases of Acute kidney injury by non RRT

目的 探索急性肾损伤（AKI）的非肾脏替代治疗（非RRT）疗法.方法 对97例AKI分别采用ABC其中一种非RRT疗法.A疗法是随机分组治疗60例,其中治疗组32例用前列地尔（PGE1）联合甘露醇及呋塞米序贯治疗,对照组28例予小剂量多巴胺联合呋塞米治疗;B疗法是肾康注射液（SKI）治疗24例;C疗法是PGE1和SKI联合甘露醇或呋塞米序贯治疗13例.结果 A疗法总有效率80.0％ （48/60）,治疗组的治愈率及总有效率均优于对照组（P＜0.05）;B疗法有效率79.2％ （19/24）;C疗法有效率100％（13/13）.全部97例中非RRT治愈或好转80例（82.5％）,需RRT 17例（17.5％）,两者比较差异有统计学意义（P＜0.01）.结论 ①大部分AKI都可经药物治疗成功,需RRT的仅是少数;②由PGE1联合甘露醇及呋塞米序贯或SKI单独或这几种药搭配序贯组成的非RRT对AKI都有较好的疗效;③治疗成功的关键是早诊断、早治疗.

Objectives To explore the therapy that non renal replacement treatment （non RRT） in acute kidney injury （AKI）.Methods 97 cases of AKI patients treated to use respectively in which a non-RRT therapy of ABC.Therapy A is randomized treatment in 60 cases,32 cases in treatment group sequential treated by alprostadil （PGE1）with mannitol and furosemide,28 cases in control group treated with small dose of dopamine and furosemide; Therapy B by Shenkang injection（SKI） in 24 cases ;Therapy C by PGE1 and SKI combined with mannitol or furosemide sequential treatment in 13 cases.Results The total effective rate was 80% （48/60）in therapy A,the cure rate and total effective rate of treatment group was better than control group（P 〈0.05） ;The total effective rate was 79.17% （19/24） in therapy B;The total effective rate was 100% （13/13）in therapy C.After the non-RRT in total 97 cases of AKI,80 cases （82.5 %） cured or improved,17 cases （17.5 %） need RRT,both comparative difference was statistically significant（P 〈 0.01） Conclusions （1） Most of AKI can be successfully treated by medication,to need RRT only a small number.（2） Non-RRT has better curative effect on AKI by PGE1 combined with mannitol and furosemide on sequential treatment or SKI alone or these combined with sequential alliance.（3）The key to successful treatment is early diagnosis and early treatment.