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2015年第5期
促红细胞生成素对心脏瓣膜术后急性肾损伤发生率的影响
Erythropoietin May Ameliorate Acute Kidney Injury after valvular Surgery
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DOI:
作者:
程劲
Cheng JIn
作者单位:
上海解放军第四五五医院肾脏科
Division of nephrology, Shanghai 455th hospital of PLA
关键词:
急性肾损伤;促红细胞生成素;心脏瓣膜手术
Acute Kidney Injury; Erythropoietin; Valvular Surgery
摘要:
目的:临床验证促红细胞生成素(EPO)能否减轻心脏瓣膜术后患者急性肾损伤。方法:前瞻、随机、对照临床实验,选择上海市胸科医院一个手术组18-70岁需要行瓣膜手术的患者,随机分为EPO组和对照组。EPO组在对照组治疗的基础上,于术前1h内和术后24h分别皮下注射EPO 1万单位。观察术后48小时急性肾损伤(AKI)的发生率,并评估相关因素。结果: 入选病例105例,因术中及术后有较严重并发症排除3例,因资料不全排除1例。剩余101例患者,发生AKI 25例,发生率为24.8%。EPO组47例,对照组54例,两组患者年龄、基础肾功能、手术时间、体外循环时间等无明显差异。EPO组AKI 1期7例,2期2例,AKI发生率19.2%;常规治疗组AKI 1期13例,2期2例,3期1例,AKI发生率29.6%,差异无统计学意义(P=0.09)。 EPO组和对照组术后48h内血肌酐升高差异不显著(17.5±37.0μmol/L vs 23.5±40.8μmol/L,P>0.05),EPO组胱抑素C升高幅度较小( 0.04±0.23μg/ml vs 0.27±0.56μg/ml,P<0.05)。 AKI患者和非AKI患者术后24h血肌酐分别是165±64 和83.8±22 μmol/L。 AKI患者年龄偏大(62.5±6.9 vs 50.1±13.2岁,P<0.01),手术时间、体外循环时间和主动脉阻断时间均明显长于非AKI患者,分别是301.4 ±108.0 vs 229.6±60.5分钟、151.3±53.5 vs 114.7±39.4分钟和101.8±31.2 vs 81.9±28.2分钟(P<0.01),AKI 组住ICU和住院天数明显长于非AKI患者。结论: 现有资料提示术前及术后注射EPO有降低心脏瓣膜术后AKI发生率的趋势, AKI者年龄大,手术时间、体外循环时间明显长于非AKI者,提示高龄和手术损伤在引起心脏瓣膜术后AKI问题上可能起着更重要的作用。
Objective: To evaluate if EPO can reduce Acute kidney injury (AKI) in patients undergoing cardiac valves surgery. Methods: prospective, random, control clinical study was conducted in 18-70 years old Patients need cardiac valves surgery. 1wU of EPO was injected Subcutaneous before operation and 24h after operation in EPO group, other treatment were the same with control group. AKI was defined as Serum creatinine was increased more than 0.3mg/dl within 48h after operation. Results: 105 patients was selected and informed consent, 3 was excluded because of serious complications in surgery, 1 was excluded because of insufficiency data. 101 patients had been completed, 47 in EPO group, 54 in control group. There was no significant difference in Age, weight, height, baseline Serum creatinine, eGFR, operation time, cardiopulmonary bypass (CBP) time and aorta block time between the two groups. The total incidence of AKI was 24.8% , 19.2% in EPO group, 29.6% in control group (P=0.09). AKI patients compared with no AKI patients, 24h after operation Scr were 165±64 and 83.8±22 μmol/L, insulin 45.8±26.4 and 28.0±19.1(P<0.05). AKI patients were more older (62.5±6.9 vs 50.1±13.2 years), had longer operation time(301.4 ±108.0 vs 229.6±60.5 minutes ) and longer CPB time(151.3±53.5 vs 114.7±39.4 minutes. Conclusion: 1. primary results showed that EPO may ameliorate acute kidney injury after cardiac valves surgery. The study sample needs to be enlarged to confirm the result.2. AKI patients had older ages and longer operation and CPB time, it is indicated that age and operation insult may play more important role in the development of AKI in cardiac valves surgery patients.
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