急性Stanford A型主动脉夹层术后急性肾损伤行连续肾脏替代疗法的效果

Effect of continuous blood purification for acute renal injury after acute Stanford type A aortic dissection

目的探讨急性Stanford A型主动脉夹层(ATAAD)术后急性肾损伤(AKI)行连续肾脏替代疗法(CRRT)的效果。方法以2017年1月至2020年1月甘肃省人民医院120例ATTAD术后并发AKI患者作为研究对象,其中男性患者86例(71.7%),女性患者34例(28.3%),年龄(55±5)岁。将患者按分层随机抽样法分为试验组(n=60)和对照组(n=60),分别行CRRT和床旁间歇性血液透析(IHD)治疗。以血液净化指标状况、肾功能指标水平、序贯器官衰竭评分(SOFA)、炎性水平以及血流动力学指标和输入液体量为评价指标,评价CRRT对ATTAD术后AKI患者的治疗效果。结果两种治疗方案对患者病情均具有良好的治疗效果,但CRRT效果更显著。试验组患者,血肌酐(SCr)、血尿素氮(BUN)、血乳酸(Lac)水平比对照组更低(均P<0.05),住ICU时间、少尿期、肾替代治疗次数、初次透析至末次透析时间、总住院时间亦均较对照组少(均P<0.05),输入液体量更少,血流动力学指标优于对照组,但两种方案的住院死亡率差异无统计学意义(P>0.05)。试验组患者IL-6、IL-8和CRP水平分别为(21.9±1.8)ng/L、(18.6±1.4)ng/L、(22.7±2.2)mg/L,显著低于对照组的(27.9±3.2)ng/L、(28.3±1.4)ng/L、(60.1±2.5)mg/L (t=14.527、13.255、11.247,均P<0.05)。试验组治疗后各时间点SOFA评分均低于对照组(均P<0.05)。结论相比IHD疗法,CRRT治疗的ATTAD术后AKI患者尽管住院病死率未表现出显著降低,但表现出更良好的预后。

Objective To investigate the effect of continuous renal replacement therapy(CRRT)on acute kidney injury(AKI)after acute Stanford type A aortic dissection(ATTAD).Methods In this study,120 patients with AKI after ATTAD surgery treat in Gansu Provincial People′s Hospital were selected as research objects.Among them,there were 86 males(71.7%)and 34 females(28.3%)with a mean age of(55±5)years.These patients were randomly divided into experimental group(n=60)and control group(n=60)with stratified random sampling.CRRT and intermittent hemodialysis(IHD)were performed in the experimental group and the control group respectively.The therapeutic effect of CRRT on ATTAD patients with AKI was evaluated by blood purification index,renal function index,Sequential Organ Failure Assessment(SOFA)score,inflammatory level,hemodynamic index and fluid infusion volume.Results The two treatment schemes both had considerable therapeutic effects on the condition of patients,but the therapeutic effect of CRRT was more superior.In the patients treated with CRRT,the levels of serium creatinine(SCr),blood urea nitrogen(BUN)and blood lactic acid(Lac)were all lower than those in the control group(all P<0.05).The time of staying in intensive care units(ICU),the period of oliguria,the times of renal replacement therapy,the time from the first dialysis to the last dialysis and the total hospital stay in the experimental group were all shorter than those in the control group(all P<0.05).The volume of fluid infusion was less and the hemodynamic index was better than that in the control group,but there was no significant difference in hospital mortality between the two groups(P>0.05).The levels of interleukin(IL)-6,IL-8 and C-reactive protein(CRP)in the experimental group were(21.9±1.8)ng/L,(18.6±1.4)ng/L and(22.7±2.2)mg/L,respectively,which were all significantly lower than those in control group((27.9±3.2)ng/L,(28.3±1.4)ng/L,(60.1±2.5)mg/L,respectively;t=14.527,13.255,11.247,all P<0.05).The scores of SOFA at all time points in the experimental group were all lower than those in the control group(all P<0.05).Conclusion Compared with IHD,CRRT brings no significant reduction in hospital mortality in patients with AKI after ATTAD,but shows better prognosis.