持续肾替代治疗在肝移植术后急性肾损伤的应用

Continuous renal replacement therapy for patients with renal failure after liver transplantation

目的 探讨持续肾替代治疗（CRRT）对肝移植术后急性肾损伤的治疗效果.方法 回顾性分析82例肝移植围手术期应用CRRT患者的肾功能情况,对其治疗前后的主要指标进行检测.结果 与治疗前比较,治疗后患者丙氨酸氨基转移酶（ALT）、总胆红素（TBil）、血尿素氮（BUN）、肌酐（Cr）、肌酸磷酸激酶（CPK）、C反应蛋白（CPR）、肌酐下降,差异均有统计学意义（P＜0.05）.与治疗前比较,CRRT治疗后患者血K＋、Na＋、Cl-、HCO3-、中心静脉压（CVP）显著好转,差异亦具有统计学意义（P＜0.05）.其他生化指标与治疗前比较变化不大,差异无统计学意义（P＞0.05）.对开始血滤治疗的时机进行研究显示,在急性肾损伤RIFLE分级Ⅰ级开始血滤治疗的患者肾功能恢复的比例明显高于在F级开始血滤治疗的患者（P＜0.05）.结论 CRRT治疗能明显改善肝移植术后急性肾损伤患者的预后.

Objective To study the therapeutic effect of continuous renal replacement therapy （CRRT） in renal failure after liver transplantation.Methods Renal function in 82 patients who underwent CRRT in the perioperative period of liver transplantation were retrospectively analyzed.Results There were significant differences in ALT,TB,BUN and Cr before and after the treatment （P 〈 0.05）.The differences were significant in glutamic-pyruvic transaminase （ALT）,creatinine phosphate kinase （CPK） and C reactive protein （CPR） before and after the treatment （P 〈0.05）.There were significant improvements in K＋,Na＋,Cl-,HCO3-and CVP before and after the treatment （P 〈 0.05）,while the differences were not significant in other biochemical parameters （P 〉 0.05）.This research also looked at the effect of timing of CRRT on renal function recovery.Based on the RIFLE classification of AKI,the ratio of renal function recovery in RIFLE-Ⅰ was significantly higher than RIFLE-F （P 〈 0.05）.Conclusion CRRT treatment significantly improved the prognosis of patients with acute renal failure after liver transplantation.