Elahi Maqsood M, Lim Ming Yann, Joseph Robin N, Dhannapuneni Ramana Rao V, Spyt Tomasz J
Department of Cardiothoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
Eur J Cardiothorac Surg. 2004 Nov;26(5):1027-31. doi: 10.1016/j.ejcts.2004.07.039.
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.
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.
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 oedema (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.
Early and aggressive use of CVVH is associated with better than expected survival in severe ARF after cardiac operations.
由于短期预后不确定，心脏手术后急性肾衰竭（ARF）患者血液滤过（连续性静脉-静脉血液滤过，CVVH）的应用及时机受到质疑。本研究的目的是确定开始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。
对2002年1月至2003年1月期间连续接受成人心脏手术的1264例患者进行审核。其中，对64例需要肾脏支持干预的患者病历进行了回顾。P<0.05被认为具有统计学意义。
在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。I组医院死亡率为43%（12例患者），II组为22%（8例）（P<0.05），ARF相关的总体死亡率为1.5%。I组手术与开始CVVH之间的平均时间为2.55±2.2天，II组为0.78±0.2天（P<0.001）。I组CVVH的平均持续时间为4.57±11.4天，II组为4.61±2.0天（P=无显著性差异）。年龄较大（P=0.013）、术前肌酐升高（P=0.002）、术后肺水肿（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。
在心脏手术后严重ARF中，早期积极使用CVVH与优于预期的生存率相关。
