自发性脑出血合并肾功能不全CRRT治疗分析

Analysis of CRRT for patients with spontaneous intracerebral hemorrhage associated with renal insufficiency

目的探讨无肝素连续性肾脏替代治疗(CRRT)对脑出血合并肾功能不全病人的治疗作用。方法回顾性分析2016年1月至2019年1月收治的42例自发性脑出血合并肾功能不全的临床资料。脑出血并发急性肾功能不全23例,其中10例接受CRRT。慢性肾功能不全继发脑出血19例,其中13例接受CRRT。结果23例脑出血继发急性肾功能不全病人出院时肾小球滤过率[GFR;32.2(21.2~47.8)ml/min]较入院时[26.5(11.7~42.5)ml/min]明显提高(P<0.05);10例CRRT病人出院时GFR改善值[17.1(0.3~47.9)ml/min]较13例未采用CRRT病人[1.5(-16.4~11.7)ml/min]有改善(P=0.063);10例CRRT病人生存时间[40.0(15.0~180.0)d]较13例未采用CRRT病人[6.5(4.3~8.6)d]明显延长(P=0.011)。19例慢性肾功能不全继发脑出血病人出院时GFR[20.0(10.3~35.2)ml/min]较入院时[12.2(8.2~19.0)ml/min]明显提高(P<0.05);13例CRRT病人出院时GFR改善值[5.3(-0.1~17.4)ml/min]与6例未采用CRRT病人[-1.1(-2.8~11.7)ml/min]无统计学差异(P=0.188);13例CRRT病人生存时间[28.0(9.5~205.0)d]与6例未采用CRRT病人[30.0(11.5~185.5)d]无统计学差异(P=0.947)。结论对于自发性脑出血合并肾功能不全病人,CRRT对于改善脑出血合并急性肾功能不全病人肾功能和生存预后的疗效更加显著,而对慢性肾功能不全继发脑出血病人的作用有限。

Objective To investigate the therapeutic effect of continuous renal replacement therapy(CRRT)on the patients with intracerebral hemorrhage(ICH)associated with renal insufficiency(RI).Methods The clinical data of 42 patients with spontaneous ICH complicated with RI were retrospectively analyzed.Of these 42 patients,23 patients suuffered from ICH complicated by acute RI of whom 10 received CRRT,and 19 of ICH secondary to chronic RI of whom 13 received CRRT.Results Of 23 patients with acute RI secondary to ICH:the glomerular filtration rate[GFR;32.2(21.2~47.8)ml/min]at discharge was significantly higher than that at admission[26.5(11.7~42.5)ml/min;P<0.05];the GFR improvement value[17.1(0.3~47.9)ml/min]of 10 patients with CRRT at discharge was higher than that of 13 patients without CRRT[1.5(-16.4~11.7)ml/min;P=0.063];the survival time of 10 patients with CRRT[40.0(15.0~180.0)d]was significantly longer than that of 13 patients without CRRT[6.5(4.3~8.6)d;P=0.011].Of 19 patients with ICH secondary to chronic RI:the GFR[20.0(10.3~35.2)ml/min]at discharge was also significantly higher than that at admission[12.2(8.2~19.0)ml/min;P<0.05];the GFR improvement value at discharge and survival time of 13 patients with CRRT did not significantly differ from those of 6 patients without CRRT(P>0.05).Conclusion For the patients with spontaneous ICH associated with RI,CRRT is more effective in improving the renal function and survival prognosis of patients with ICH caomplicated by acute RI,but has limited effect on the patients with ICH secondary to chronic RI.