Clinical Application Of Continuous Renal Replacement Therapy In Patients With ARF After Cardiac Surgery

【Objectives】Continuous renal replacement treatment(CRRT) has become a part of thecomprehensive treatment of critically ill patients and It is an effective treatment means inpatients with acute renal failture (ARF) after cardiac surgery，too. The study is to explorethe relationship between the physiological and biochemical indicators before CRRT andprognosis of patients in order to better prevention and treatment of ARF.【Methods】Severe cases receiving CVVHDF more than24hours in the Intensive CareUnit(ICU) of Xi Jing Hospital from March2013to March2014，with ARF subsequent todifferent types of cardiac surgery were analyzed retrospectively. Those who weresurvival time of less than72hours and who had heart disease with other diseases (such as:chronic kidney disease, hypertension, diabetes, chronic lung disease, malignant tumor,etc.) and who had ARF before cardiac surgery were excluded，as well as lack of clinicaldata.31cases were analyzed at the end. They were divided into two groups according toprognosis：18survival as survival group and13death as death group. The patients’general characteristics were recorded， AKI classification and APACHE II score wereevaluated. Serum creatinine (Scr)、blood urea nitrogen(BUN)、the serum concentrationK+、heart rate(HR)、mean arterial pressure(MAP) and central venous pressure(CVP)recorded before、24hours and48hours after the initiation of CRRT were analyzed andcompared.【Results】 1.The average age of31patients were49.55±11.92years old，APACHEII scorewas18.03±4.30scores，The average serum creatinine values before CRRT treatmentwas368.71±160.40umol/L；2. APACHEII scores、 Serum creatinine、 blood urea nitrogen、 the serumconcentration K+and heart rate of all31patients after CRRT were significantly decreased（all P<0.05）and mean arterial pressure was increased（P<0.05) than before CRRT；3. Compared with survival group，the time from the initiation of CRRT treatment toAKI is long，the number of concurrent viscera function failure is more，before theinitiation of CRRT treatment APACHEII score and serum creatinine level is higher andmean arterial pressure is lower（all P＜0.05） in death group. After survival group ofpatients with heart rate and mean arterial pressure returning to normal，The CRRTtreatment process is relatively stable；4. Multi-factor Logistic regression analysis step by step found that before CRRTtreatment Serum creatinine and mean arterial pressure before CRRT treatment areindependent factors affecting patients died，including serum creatinine values before theCRRT treatment is predict the risk of death factors（OR：1.020，95%CI:1.003~1.037)，mean arterial pressure in front of the CRRT treatment is protective factor(OR:0.811，95%CI:0.674~0.977). Omnibus Tests of Model Coefficients suggested χ2=23.821，P<0.001. Before CRRT treatment area under curve of serum creatinine was0.829(95%CI:0.665~0.993). Before CRRT treatment area under curve of mean arterialpressure was0.714(95%CI:0.521~0.907). Before CRRT treatment serum creatnine valuesof347mmol/L as the cutoff value，the sensitivity to predict patients died was84.6%，thespecificity was83.3%； Before CRRT treatment mean arterial pressure values of71.4mmHg as the cutoff value，the sensitivity to predict patients died was72.2%，thespecificity was69.2%.【Conclusions】1.Most of the CSA-AKI patients before CRRT treatment has been existed differentdegrees of AKI； 2.Whether live or die group，the related parameters after CRRT treatment havedifferent degrees of improvement；3.The time from the initiation of CRRT treatment to AKI and the number ofconcurrent viscera function failure may be the leading cause of death in patients；4.Before CRRT treatment serum crearnine and mean arterial pressure can be used aspredictors of prognosis of patients and to guide the early initiation of CRRT treatment.