Kunt Atike Tekeli, Akgün Serdar, Atalan Nazan, Bitir Nazan, Arsan Sinan
Department of Cardiovascular Surgery, Bahçelievler Medicana Hospital, Istanbul, Turkey.
Anadolu Kardiyol Derg. 2009 Dec;9(6):499-504.
Acute kidney injury (AKI) is a devastating complication following cardiac surgery and the ideal management is controversial. This prospective, randomized, open-label and double-blinded study analyzed the renoprotective effects of furosemide infusion and intermittent bolus therapy administered with dopamine infusion in cardiac surgical patients.
Between August 1, 2007 and July 31, 2008, 100 adult patients undergoing elective coronary artery bypass surgery (CABG) surgery with normal renal function (creatinine <1.4 mg/dl) were enrolled in the study. The patients were randomized for the comparison of intermittent (Group 1, n=50, 1mg-3mg/kg) and continuous infusion of furosemide (Group 2, n=50, 10mg/ml). Continuous variables were expressed as mean+/- SD and compared by unpaired Student's t test or ANOVA for repeated measures. Statistical significance was assumed if p value was <0.05.
Renal replacement therapy (RRT) was used in 5% of patients (all in group 1, p=0.028). The 30-day mortality was 5%. Only 2 patients became hemodialysis dependent in group 1. Group 2 patients showed a continuous and higher urine output postoperatively than group 1 (p<0.001). Both groups had significant increase in peak postoperative serum creatinine values (p<0.001), however peak postoperative creatinine-clearance was significantly lower in group 1 (p<0.001).
Acute kidney injury necessitating RRT makes a small percentage of patients undergoing cardiac surgery and if RRT is not required the survival is excellent. Continuous infusion of furosemide seems to be effective in promoting diuresis and decreasing the need for RRT. However further multicenter studies with different doses of furosemide are required to confirm these results.
急性肾损伤（AKI）是心脏手术后一种严重的并发症，其理想的治疗方法存在争议。本前瞻性、随机、开放标签和双盲研究分析了在心脏手术患者中静脉输注速尿及联合多巴胺间歇性推注治疗的肾脏保护作用。
2007年8月1日至2008年7月31日期间，100例肾功能正常（肌酐<1.4mg/dl）的择期冠状动脉旁路移植术（CABG）成年患者纳入本研究。患者被随机分组，比较间歇性静脉推注速尿（第1组，n = 50，1mg - 3mg/kg）和持续静脉输注速尿（第2组，n = 50，10mg/ml）。连续变量以均值±标准差表示，采用非配对学生t检验或重复测量方差分析进行比较。p值<0.05时认为具有统计学意义。
5%的患者接受了肾脏替代治疗（RRT）（均在第1组，p = 0.028）。30天死亡率为5%。第1组仅2例患者依赖血液透析。第2组患者术后尿量持续高于第1组（p<0.001）。两组术后血清肌酐峰值均显著升高（p<0.001），然而第1组术后肌酐清除率峰值显著更低（p<0.001）。
需要进行RRT的急性肾损伤在接受心脏手术的患者中占比很小，若无需RRT，生存率良好。持续静脉输注速尿似乎能有效促进利尿并减少RRT需求。然而，需要进一步开展不同速尿剂量的多中心研究来证实这些结果。
