连续肾脏替代疗法联合新活素在心脏术后急性肾功能衰竭的疗效评价

Evaluation of the therapeutic effect of continuous renal replacement therapy and recombinant human brain natrinretic peptid for acute renal failure after cardiac surgery

目的 探讨连续肾脏替代疗法（CRRT）联合使用静脉泵注新活素（冻干重组人脑利钠肽）在心脏外科术后急性肾功能衰竭（ARF）中的治疗效果.方法 回顾分析既往心脏外科直视术后出现ARF的患者,其中综合治疗组（对照组）47例,综合治疗包括应用CRRT、血管活性药物和其他辅助治疗.治疗组在对照组基础上联合使用新活素,共42例.比较两组患者治疗前后尿量、血肌酐水平、左室射血分数、心指数、中心静脉压、平均动脉压、CRRT持续时间及预后.结果 治疗组患者在治疗24 h、72 h时的尿量分别为（107.61±230.43）ml/h、（163.74±180.63）ml/h,血肌酐水平分别为（134.94±53.51）μmol/L、（94.47±78.36）μmol/L,较对照组均有显著改善（P＜0.01）;中心静脉压[治疗组24小时为（17.8±5.2）cm H2O,72小时为（11.4±7.7）cm H2O]及平均动脉压[治疗组24小时为（55.80±18.47）mm Hg,72小时为（89.30±16.98）mm Hg]较对照组也有较明显改善（P＜0.05）;但心功能指标（左室射血分数、心指数）改善不明显;治疗组CRRT持续时间（89.5±23.2）h较对照组（175.4±26.7）h也明显缩短;对照组除2例转为普通日间血透,死亡病例共9例,治疗组死亡4例.结论 心脏外科直视术后出现ARF的患者,在CRRT的同时联用新活素可加快肾功能和尿量的恢复,缩短CRRT的使用时间,改善预后.

Objective To evaluate the therapeutic efficiency of continuous renal replacement therapy （CRRT） and recombinant human brain natrinretic peptid （rhBNP） for acute renal failure （ARF） after cardiac surgery.Methods The clinical data of patients,with ARF undergoing cardiac surgery,was retrospectively studied.There were 47 cases given combined therapy （control group）,including the application of CRRT,vasoactive drugs and other supportive therapy.A total of 42 cases were in therapy group,who were intravenously given rhBNP based on combined therapy.Urine volume,serum creatinine,left ventricular ejection fraction,cardiac index,central venous pressure,mean arterial pressure,CRRT duration and prognosis were measured before and after treatment between the two groups.Results The urine volume of the patients in the treatment group were （107.61±230.43）ml/h,（163.74±180.63）ml/h at 24 h and 72 h respectively.The serum creatinine level were （134.94±53.51）tμmol/L,（94.47±78.36）μ.mol/L respectively.There were significantly improved （P〈0.01） compared with the control group.Central venous pressure [（17.8±5.2）cm H2O,（11.4±7.7）cm H2O at 24 h and 72 h respectively in treatment group] and mean arterial pressure [（55.80±18.47）mm Hg,（89.30±16.98）mm Hg at 24 h and 72 h respectively in treatment group] compared with control group also had some improvement （P〈0.05）.But there was no improvement in cardiac function （left ventricular ejection fraction,cardiac index）.CRRT treatment duration,what was （89.5±23.2）h in treatment group and （175.4±26.7）h in the control group,was significantly shortened compared between the two.In the control group,except for 2 cases converted to normal daytime hemodialysis,there were 9 cases of death and 4 cases of death in the treatment group.Conclusion rhBNP may efectively improve renal function of patients with ARF undergoing cardiac surgery,shorten CRRT treatment duration and improve the prognosis.