连续性肾脏替代治疗在急性下肢缺血术后肌病肾病代谢综合征患者的围术期疗效观察

Observation of the perioperative effect of continuous renal replacement therapy in patients with myonephropathic metabolic syndrome caused by acute lower limb ischemia after surgery

目的:探讨连续性肾脏替代治疗(CRRT)急性下肢缺血术后发生肌病肾病代谢综合征(MNMS)患者的围术期中的作用,为CRRT在此类患者中的应用提供参考。方法:回顾性分析2005年至2016年,收治的急性下肢缺血术后发生MNMS的患者63例,比较29例行CRRT治疗和34例未行CRRT治疗患者,在围术期临床资料及术后1周检验指标的变化。结果:CRRT组ICU停留时间长于无CRRT组(P<0.05)。平均CRRT治疗时长(9.0±7.3)d。CRRT组死亡2例,病死率6.9%。无CRRT组死亡4例,病死率11.8%。CRRT组术后5~7d血肌酐水平、4~7d血肌红蛋白和肌酸激酶水平、3~7d的HGB水平、术后第5和第7日血钾水平及术后尿量均明显低于无CRRT组(P<0.05)。术后第7日与手术当日比较,两组患者血肌红蛋白、肌酸激酶、天冬氨酸转氨酶和乳酸水平均明显降低,CRRT组的血肌酐、HGB及血钾水平均明显降低,CRRT组脱水量明显增加(P<0.05)。结论:CRRT能够有效去除血中肌红蛋白,对于肌红蛋白及肌酸肌酶明显升高、肾功能显著减退的急性下肢缺血的MNMS患者术后应尽早应用CRRT,可以降低血肌红蛋白和肌酸激酶的水平,减轻横纹肌和肾脏损伤,维持内环境平稳,保护各脏器功能,对MNMS的防治是安全有效的。

Objective： To study the perioperative effect of continuous renal replacement therapy （CRRT） in postoperative treatment of myonephropathic metabolic syndrome （MNMS） caused by acute lower limb ischemia and provide reference for the application of CRRT in this kind of patients. Methods ： Retrospectively analyzed 63 cases of MNMS caused by acute lower limb ischemia after surgery. The perioperative clinical data and lab test results in one week after surgery of 29 CRRT treated patients and 34 non-CRRT treated pa- tients were compared. Results： The ICU length of stay in CRRT group was higher than in non-CRRT group（P 〈 0. 05 ）. The average length of CRRT was （9. 0 -＋ 7.3 ） days. Two patients died in CRRT group with mortality rate of 6. 9%. Four patients died in non-CRRT group with mortality rate of 11.8%. The postoperative seruin creatinine level from 5 to 7 days, myoglobin and creatine kinase level from 4-7 dyas, haemoglobin level from 3 to 7 days, potassium level at day 5 and day 7 and urine output after surgery in CRRT group were lower than in non-CRRT group（ P 〈0. 05）. The myoglobin, creatine kinase, aspartate transaminase and lactic acid levels in both groups and the serum creatinine, haemoglobin and potassium level in CRRT group on day 7 after surgery were significantly lower compared to those on the day of surgery and the amount of dehydration increased signifi- cantly in CRRT group （ P 〈 0. 05 ）. Conclusion ： CRRT is able to remove serum myoglobin effectively. In MNMS patients with significantly increased myoglobin and creatine kinase level and decreased kidney function after acute lower limb ischemia surgery, early application of CRRT can reduce the level of serum myoglobin and creatine kinase as early as possible, alleviate the injury of striated muscle and kidney, maintain homeostasis, and protect organ function. CRRT is safe and effective in the prevention and treatment of MNMS.