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目的探讨连续性血液净化不同剂量对心脏手术相关急性肾损伤(cardiac surgery associated acute kidney injury,CSA-AKI)患者预后的影响。方法 2013年11月~2016年2月在广东省人民医院就诊的符合纳入和排除标准的患者共151例,随机分为两组:高剂量组35ml/(kg.h)78例,低剂量组25 ml/(kg·h)73例,观察终点为随机分组后14天、28天、90天的全因死亡率及肾脏的恢复情况。结果 ITT分析及Kaplan-Meier生存分析结果显示,高剂量组和低剂量组的患者14天(63.4%比65.7%,χ2=0.591,P=0.442)、28天(54.5%比55.6%,χ2=1.232,P=0.267)以及90天(45.5%比47.5%,χ2=2.810,P=0.094)生存率均无显著性差异。CRRT治疗不同剂量对14天(14.3%比10.1%,χ2=2.011,P=0.570)、28天(22.3%比18.2%,χ2=1.524,P=0.674)、90天(25.0%比18.4%,χ2=4.560,P=0.207)存活的CSAAKI患者肾功能恢复情况的影响无显著性差异。结论 CRRT治疗不同剂量25ml/(kg·h)与35ml/(kg·h)对CSA-AKI患者的临床预后无明显差别,包括14天、28天、90天患者死亡率和肾脏功能恢复。
Objective To investigate the effect of different doses of continuous blood purification on the prognosis of patients with cardiac surgery associated acute kidney injury (CSA-AKI). Methods A total of 151 eligible patients admitted to Guangdong Provincial People’s Hospital from November 2013 to February 2016 were randomly divided into two groups: high dose group (n = 78), low dose group (n = 78), low dose group 25 ml / (kg · h) 73 cases, the end of the randomized study was 14 days, 28 days, 90 days of all-cause mortality and kidney recovery. Results The ITT analysis and Kaplan-Meier survival analysis showed that patients in the high-dose and low-dose groups were 14 days (63.4% vs. 65.7%, χ2 = 0.591, P = 0.442) and 28 days (54.5% vs. 55.6%, χ2 = 1.232, P = 0.267) and 90-day survival rates (45.5% vs 47.5%, χ2 = 2.810, P = 0.094) did not differ significantly. CRRT was also effective at different doses for 14 days (14.3% versus 10.1%, χ2 = 2.011, P = 0.570), 28 days (22.3% vs. 18.2%, χ2 = 1.524, P = 0.674), 90 days (25.0% vs. 18.4% χ2 = 4.560, P = 0.207) There was no significant difference in the recovery of renal function in CSAAKI patients who survived. Conclusions The clinical outcomes of CSA-AKI patients treated with CRRT at different doses of 25ml / (kg · h) and 35ml / (kg · h) have no significant difference, including 14 days, 28 days and 90 days mortality and renal function recovery.