Stanford A型主动脉夹层术后并发急性肾损伤行连续性肾脏替代治疗时机的选择

目的探讨Stanford A型主动脉夹层术后并发急性肾损伤选择连续性肾脏替代治疗(CRRT)的时机。方法回顾我院2009年1月—2013年6月收治的Stanford A型主动脉夹层术后并发肾功能衰竭患者16例,均选择CRRT,按透析介入时机不同分为A、B两组,A组为术后发现血肌酐>442μmol/L或K+>6.5 mmol/L或24 h无尿即进行CRRT,B组为术后发现血肌酐进行性升高且>260μmol/L或K+进行性升高且>5.5 mmol/L或尿量较前有减少趋势即进行预防性CRRT,观察两组CRRT持续时间、ICU时间及转归等。结果 B组CRRT持续时间、ICU留住时间明显短于A组,医疗费用明显少于A组(均P<0.05)。结论 CRRT的合理干预是治疗主动脉夹层术后急性肾损伤成功的关键。

Continuous renal replacement therapy for acute renal failure after surgical management of Stanford type A aortic dissection

Objective To analyze the optimal time and the outcome of continuous renal replacement therapy （CRRT） in acute re- nal failure after Stanford type A aortic dissection. Methods We retrospectively analyzed 16 patients with renal failure after surgery for Stanford type A aortic dissection admitted to our hospital from January 2009 to June 2013. They all were treated with CRRT. According to clinical laboratory test before CRRT, the patients were divided into two groups. Group A consisted of the patients with postoperative serum ereatinine 〉 442 μmol/L or K ＋ 〉 6.5 mmol/L or anuresis during 24 hours, and Group B included those with an increase in postoperative serum creatinine 〉 260 μmol/L or K ＋ 〉 5.5 mmol/L or a trend of decrease in urine volume. The du- ration of CRRT and the time of stay in ICU, as well as their outcomes were analyzed. Results The duration of CRRT and the time of stay in ICU were significantly shorter in Group B than in group A; as for medical cost and mortality, they were both significantly lower in Group B than in group A （P 〈 0.05 ）. Conclusion Proper intervention of CRRT is the key to the success of the treatment of acute kidney injury after surgical management of Stanford type A aortic dissection.