Wiebe K, Meyer M, Wahlers T, Zenker D, Schulze F, Michels P, Dalichau H, Mohr F W, Borst H, Forssmann W G
Klinik für Herz-, Thorax- und Gefässchirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Eur J Med Res. 1996 Feb 22;1(5):259-65.
Acute renal failure (ARF) is a serious complication following cardiac surgery. This first controlled study was undertaken to verify, if Urodilatin (URO) infusion can revert incipient oliguric ARF after cardiac surgery. We conducted a randomized, double blind trial comparing 7 URO (20 ng/kg/min) with 7 placebo patients. Inclusion criterion was oliguria/anuria (< 0.5 ml/kg/hour) refractory to conventional treatment including administration of dopamine and furosemide. No patient in the URO treated group, but 6 patients in the placebo group had to be hemofiltered or hemodialyzed (p < 0.005) during the 7 day treatment period. In the URO group all 7 patients demonstrated a rapid recovery of diuresis after 2 - 8 hours of treatment that persisted throughout the treatment period. In contrast, placebo treated patients remained oliguric. Serum creatinine (SC) decreased in URO treated patients. No adverse effects were observed during URO administration. After termination of URO, 2 patients underwent hemodialysis for elevated blood urea nitrogen (BUN) values. In the postoperative follow-up period of 60 days, 4 out of 7 placebo treated patients died while still on hemodialysis. In contrast, all URO patients survived. URO is an effective drug to reverse oliguric ARF following cardiac surgery. Prolonged renal failure and renal replacement therapy can be avoided.
急性肾衰竭(ARF)是心脏手术后的一种严重并发症。开展的这项首个对照研究旨在验证,输注尿舒张素(URO)能否逆转心脏手术后初期的少尿型ARF。我们进行了一项随机双盲试验,将7例接受URO(20纳克/千克/分钟)治疗的患者与7例接受安慰剂治疗的患者进行比较。纳入标准为对包括使用多巴胺和呋塞米在内的传统治疗无效的少尿/无尿(<0.5毫升/千克/小时)。在7天的治疗期内,URO治疗组无患者需要进行血液滤过或血液透析,但安慰剂组有6例患者需要进行此类治疗(p<0.005)。在URO组,所有7例患者在治疗2至8小时后尿量迅速恢复,且在整个治疗期内持续保持。相比之下,接受安慰剂治疗的患者仍处于少尿状态。URO治疗的患者血清肌酐(SC)下降。在输注URO期间未观察到不良反应。停用URO后,有2例患者因血尿素氮(BUN)值升高而接受血液透析。在60天的术后随访期内,7例接受安慰剂治疗的患者中有4例在仍接受血液透析时死亡。相比之下,所有接受URO治疗的患者均存活。URO是一种逆转心脏手术后少尿型ARF的有效药物。可避免肾衰竭的延长及肾脏替代治疗。