Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure
Early hemofiltration improves survival in post-cardiotomy patients with acute renal failure
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DOI：
10.1016/j.ejcts.2004.07.039
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发表时间：
2004-11-01
影响因子：
3.4
通讯作者：
Spyt, TJ
中科院分区：
文献类型：
--
作者：
Elahi, MM;Lim, MY;Spyt, TJ
目的：由于短期结局不确定，血液滤过（连续性静脉-静脉血液滤过，CVVH）在心脏手术后急性肾功能衰竭（ARF）患者中的应用和时机受到质疑。本研究的目的是确定引入血液滤过的时机如何影响心脏手术后ARF患者的发病率和死亡率。方法：2002年1月至2003年1月期间接受成人心脏外科手术的1264例连续患者进行了审计。其中，审查了64例需要肾脏支持性干预的患者的病例记录。结果：64例（5%）发生ARF并需要CVVH的患者中，男性48例，女性16例。平均年龄为70 ± 6.8岁。住院死亡率为43%（12例患者），组II为22%（8例）（P < 0.05），与ARF相关的总死亡率为1.5%。组I从手术到开始CVVH的平均时间为2.55 ± 2.2天，组II为0.78 ± 0.2天（P < 0.001）。组I中CVVH的平均持续时间为4.57 ± 11.4天，组II中为4.61 ± 2.0天（P = NS）。年龄较大（P = 0.013），术前肌酐升高（P = 0.002），术后肺水肿a（P = 0.01），脓毒症（P = 0.001），多器官功能衰竭（P = 0.031），低血压（P = 0.031）和术前肾功能衰竭（P < 0.05）是影响术后不良结局和心脏不稳定的独立因素。心脏手术后重度ARF患者早期积极使用CVVH的生存率高于预期。(C)2004 Elsevier B. V.保留所有权利。
Objective: The application and timing of hemofiltration (continuous veno-venous hemofiltration, CVVH) in patients with acute renal failure (ARF) post cardiac surgery has been called into question because of uncertain short-term outcome. The aim of the present study was to identify how the timing of introduction of hemofiltration affects the morbidity and mortality in patients with ARF after cardiac surgery.Methods: 1264 consecutive patients who underwent adult cardiac surgical procedures performed between January 2002 and January 2003 were audited. Out of these, case notes of 64 patients who required renal supportive intervention were reviewed. statistical significance was accepted at a level of P < 0.05.Results: Of the 64 (5%) patients, who developed ARF and required CVVH, there were 48 males and 16 females. Mean age was 70 +/- 6.8 years. The hospital mortality was 43% (12 patients) in Group-I and 22% (8) in Group-II (P < 0.05), giving an overall 1.5% mortality associated with ARF. The mean time between the operation and the initiation of CVVH was 2.55 +/- 2.2 days in Group-I and 0.78 +/- 0.2 days in Group-II (P < 0.001). The mean duration of CVVH was 4.57 +/- 11.4 days in Group-I and 4.61 +/- 2.0 days in Group-II (P = NS). Older age (P = 0.013), elevated preoperative creatinine (P = 0.002), postoperative pulmonary oeden a (P = 0.01), sepsis (P = 0.001), multiple organ failure (P = 0.031), hypotension (P = 0.031) and preoperative renal failure (P < 0.05) were the independent factors influencing the poor postoperative outcome and cardiac instability.Conclusion: Early and aggressive use of CVVH is associated with better than expected survival in severe ARF after cardiac operations. (C) 2004 Elsevier B.V. All rights reserved.