早期连续性肾脏替代治疗对心脏骤停后综合征患者肾功能影响的研究

Impact of early initiation of continuous renal replacement therapy on renal function in patients with post-cardiac arrest syndrome

目的探讨早期连续性。肾脏替代（CRRT）治疗对心脏骤停后综合征患者肾功能的影响，为完善其临床治疗机制提供数据支撑。方法选取浙江衢化医院2008年10月—2013年3月ICU接收的62例（≥18岁）心脏骤停后、自主循环恢复患者为研究对象，采用随机数字法分为2组；对照组32例给予心肺复苏术以及肾上腺素等综合治疗，观察组30例在综合治疗的基础上给予早期CRRT治疗。分别于治疗前后抽取患者的外周静脉血和桡动脉血，以全自动生化分析仪测定肾功能指标（BUN、Scr、BMG、BUA），以血气分析仪测定动脉血气（pH值、PaCO2、PaO2）和电解质指标（HCO3-、Na＋及K＋）；同时，采用彩色多普勒超声测定肾主动脉血流动力学指征（PSV、EDV、Vm及RI），并记录治疗后急性肾功能衰竭发生率。所得数据均以统计学软件SPSS17．0处理，计数资料行Fisher检验，计量资料行t检验。结果2组患者治疗前各项考察指标均无统计学意义（t=0．132—1．896，P=0．907～0．084）。治疗后，观察组静脉血BUN、Scr、BMG、BUA血清水平显著低于对照组（t=9．834～38．43，P=0．000）；动脉血PaO，水平显著高于对照组（t=4．771，P=0．009），PaCO3、K＋、Na＋显著低于对照组（t=3．185—4．813，P=0．019—0．007）；同时，。肾主动脉PSV、EDV、Vm显著高于对照组（t=2．746～4．463，P=0．028～0．011），RI显著低于对照组（t=2．285，P=0．043）。此外，观察组治疗后急性。肾功能衰竭的发生率为18．76％（6例），显著小于对照组的71．88％（23例）（x2=18．223，P=0．ooo）。结论在综合治疗的基础上，给予心脏骤停后综合征患者早期CRRT治疗有助于保护患者的肾功能，对改善患者预后有意义，值得在临床上推广应用。

Objective To explore the impact of early initiation continuous renal replacement therapy （CRRT） on renal function in patients with post cardiac arrest syndrome（ PCAS）, and provide the basis for the understanding of therapeutic mechanism. Methods Total 64 cases of resumption of spontaneous circulation（ ROSC） after a cardiac arrest（≥ 18 years old） admitted to ICU from October 2008 to March 2013 were divided into two groups randomly： Patients in Control group （ n = 30） were given comprehensive treatment, such as cardiopulmonary resuscitation and epinephrine ; and patients in Ob- servation group（ n = 30） were given CRRT in early stage on base of Control group. The peripheral blood and arterial blood of every patient was extracted before and after treatment to test the renal function （ BUN, Scr, BMG and BUA） with fully automatic biochemical analyzer and arterial blood gases（ pH, PaCO2 and PaO2 ）, electrolyte（ HCO3 - , Na ＋ and K ＋ ） with blood-gas analyzer. At the same time, hemodynamics of renal artery （ PSV, EDV, Vm and RI ） was detected with color Doppler ultrasound, and the incidence of renal failure was also considered. All data were analyzed with statistical software SPSS 17. O, and enumeration data were compared with the Fisher test, while measurement data were compared with t-test and F-test. Results Before treatment, there was no significant difference between groups in all indicators （t = O. 132 - 1. 896,P = O. 907 - 0. 084）. After treatment, the serum lever of BUN, Scr, BMG and BUA of patients in the Observation group were all significantly lower than those in the Control group （ t = 9. 834 - 38.43, P = 0. 000 ） ; PaO2 level of arterial blood of the Observation group were all significantly higher than those in the Control group （ t = 4.771, P = 0.009 ）, while PaCO2 , K ＋ and Na ＋ opposite （ t = 3. 185 - 4.813,P = O. 019 - 0. 007 ） ; and renal aortal PSV, EDV and Vm of the Obser- vation group were all significantly higher than those in the Control group（ t = 2. 746 -4. 463, P = 0. 028 -O. O11 ）, while RI opposite （ t = 2. 285, P = 0. 043 ）. Furthermore, the incidence rate of acute renal failure were of patients in Observation group was 18.76% （4 cases）, which was significant lower than that in Control group （ 71.88% 23 cases ）, X2 = 18. 223, P = 0. 000. Conclusion On the basis of comprehensive treatment, the early initiation of CRRT in patients with PCAS can help to protect the patient＇ s kidney function and has positive effect on improving the prognosis of patients, which is worthy of popularization and application on clinic.