心脏术后体外膜肺氧合患者应用肾替代治疗的时机分析

Analysis about the timing of renal replacement therapy in patients with extracorporeal membrane oxygenation after cardiac surgery

目的分析心脏术后体外膜肺氧合（ECMO）患者应用肾替代治疗（RRT）的应用时机。方法选择心脏术后出现心源性休克而行ECMO辅助治疗以及RRT的88例患者,按照患者行RRT治疗时间,将RRT指征前运用RRT治疗的患者50例作为早期组,在RRT指征后运用RRT治疗的38例患者作为晚期组,比较两组患者临床资料、治疗预后情况。结果两组患者多器官衰竭、下肢缺血以及感染发生率比较,差异均无统计学意义（χ^2分别=0.02、0.86、0.01,P均〉0.05）,而早期组患者死亡率、ECMO辅助治疗时间以及住院时间均明显低于晚期组,差异均有统计学意义（χ^2=3.98,t分别=2.83、5.27,P均〈0.05）;两组患者治疗72 h后血肌酐（SCr）、尿素氮（BUN）、平均动脉压（MAP）、左心射血分数（EF）以及氧合指数均有明显改善,差异均有统计学意义（t分别=6.74、19.81、7.88、9.73、5.70;3.31、9.27、4.98、4.39、3.19,P均〈0.05）,且早期组治疗72 h后改善情况明显优于晚期组,差异均有统计学意义（t分别=3.01、8.34、2.75、3.39、2.80,P均〈0.05）。结论在发生急性肾损伤的早期给予心脏术后心源性休克行ECMO辅助治疗患者RRT治疗,有助于患者机体功能的恢复并改善患者预后。

Objective To analyze the application timing of renal replacement therapy（RRT） in patients with extracorporeal membrane oxygenation（ECMO） after cardiac surgery. Methods A total of 88 patients with cardiogenic shock that underwent ECMO adjuvant therapy and RRT were enrolled and divided into early treatment group（n=50） and late treatment group（n=38） according to the application timing of RRT. The clinical data and prognosis between two groups were compared. Results The incidence multiple organ failure, limb ischemia and infection rate between two groups were not significantly different（χ^2=0.02, 0.86, 0.01, P〉0.05）. The mortality, ECMO treatment time and hospitalization time of early treatment group were significantly lower than those of late treatment group（χ^2=3.98,t=2.83, 5.27,P〈0.05）. After 72 hours of treatment, the serum creatinine（SCr）, blood urea nitrogen（BUN）, mean arterial pressure（MAP）, left ventricular ejection fraction（EF） and oxygen index of two groups were significantly improved（t =6.74,19.81,7.88,9.73,5.70,3.31,9.27,4.98,4.39,3.19, P 0.05）, and those indexes in early treatment group after 72 hours treatment were significantly better than the late treatment group（t=3.01,8.34,2.75,3.39,2.80,P〈0.05）. Conclusion In early period of acute kidney injury, it recommends to give RRT treatment for the patients with extracorporeal membrane oxygenation after cardiac surgery for after open heart surgery. It is benefit for the body functions recovery and prognosis.