连续性肾脏替代治疗介入时机对主动脉夹层术后急性肾损伤患者预后的影响

Effect of continuous renal replacement therapy on prognosis of patients with acute renal injury after aortic dissection repair

目的分析连续性肾脏替代治疗(CRRT)介入时机与主动脉夹层术后急性肾损伤(AKI)患者预后的关系。方法选择主动脉夹层术后出现AKI并接受CRRT治疗的患者,回顾性分析患者的临床资料,随访患者预后,以术后2 d为时间节点,2 d内(≤2 d)开始行CRRT治疗为早期透析组,2 d后为晚期透析组,比较早期透析与晚期透析对患者预后的影响。结果纳入83例患者进行分析,其中早期透析治疗组46例,晚期透析治疗组37例。早期透析治疗组较晚期透析治疗组术前血肌酐值较高(182.20μmol/L vs.126.86μmol/L),利尿剂使用较少(45.65%vs.70.27%)。与晚期透析治疗组相比,早期透析治疗组90 d死亡率低(43%vs.68%),ICU治疗时间短(9.76 d vs.15.32 d),但28 d、60 d死亡率、肾功能恢复情况、CRRT治疗时间、住院时间、机械通气时间无统计学差异。结论早期行CRRT治疗可降低主动脉夹层术后AKI患者90 d死亡率。

Objective To analyze the relationship between timing of continuous renal replacement therapy intervention and the prognosis of patients with acute renal injury after aortic dissection repair.Methods Patients who developed AKI after aortic dissection repair and received CRRT treatment were selected.Two days after surgery was used as the cut-off point for early and delayed groups to enable subsequent comparisons.Results Among the 83 patients,46 patients were assigned to the early group and 37 patients were assigned to the delayed group.The preoperative serum creatinine was higher(182.20μmol/L vs.126.86μmol/L),while the diuretics were less used(45.65%vs.70.27%)in the early group.Compared with the delayed group,no significant difference in the 28-day mortality,60-day mortality,recovery of renal function,duration of RRT,hospital stay,duration of mechanical ventilation was found.However,the early group had a lower 90-day mortality rate(43%vs.68%),and a shorter length of ICU stay.Conclusion Among patients with acute renal failure after aortic dissection repair,early initiation of CRRT reduced mortality over the first 90 days.