高龄食管癌患者术后并发急性肾损伤的治疗

Acute kidney injury treatment for elderly patients after esophageal cancer operation

目的 分析高龄食管癌患者术后并发急性肾损伤（AKI）的治疗及血液净化的疗效.方法 回顾性分析山西省人民医院胸外科从2010年1月至2012年12月食管癌患者262例,术后并发AKI患者23例,AKI组根据AKI分级标准分为3级,其中AKI 1级13例、2级7例、3级3例.分析AKI可能的病因、处置及转归.结果 AKI组与非AKI组比较,糖尿病为围手术期AKI高危因素.而两组术前尿素氮、血肌酐、术中平均出血量、手术时间比较差异均无统计学意义.AKI组患者术中出现低血压发生率明显高于非AKI组.20例AKI患者经对症支持等治疗后痊愈,AKI 3级患者中2例经及时床旁血液滤过治疗后,痊愈出院.1例未经血液滤过治疗而死亡.结论 高龄食管癌患者术后并发AKI主要与年龄、低血压、糖尿病等因素有关.对于此类患者,需严密监测肾功能变化,祛除可能的诱因.一旦发生AKI 3级,应尽早行床旁血液滤过治疗.

Objective To analyze the outcome of elderly patients with acute kidney injury（AKI） after esophageal cancer operation and the effect of blood purification.Methods 23 patients with AKI,in the department of thoracic surgery in Shanxi Provincial People＇s Hospital,were analyzed retrospectively after 262 esophageal cancer operations from January 2010 to December 2012.AKI can be classified into three levels,in which,13 cases for AKI first level,7 cases for AKI second level and three cases for AKI third level.The possible causes of AKI,disposal and outcomes were analyzed in the research.Results Comparing AKI group with un-AKI group after Esophageal cancer operation,diabetes is a high risk factor for AKI in perioperative period.There is no difference in BUN,SCr,average blood amount in the operation and operation duration time between two groups.The rate of low pressure occured in AKI groups is much higher than that of in un-AKI group.20 patients with AKI have been totally recovered after symptomatic and supportive treatment.Two cases among patients who are AKI third level received timely bedside hemofiltration and were fully recovered.One patient has been dead without hemofiltration treatment.Conclusion After the esophageal operations were peroformed,the elderly patients with AKI is mainly related with such factors as age,low blood pressure,diabetes and so on.For such elderly patients,we should monitor the renal function changes closely and eliminate possible causes.Once AKI 3 class occurs,bedside hemofiltration is needed as soon as possible.