直穿法置管腹透在高龄重症急性肾衰患者中的应用

Acute Peritoneal Dialysis with Percutaneously Placed Catheter in Aged Intensive Care Patients with Acute Kidney Injury

摘要: 目的：评估直穿法置管腹透能否延长高龄重症急性肾衰患者的生存时间。方法：选取年龄大于75岁的重症监护患者出现急性肾衰的，予直穿法置管腹透为治疗组(A组)，基线特征匹配的未透析的为对照组(B组)。结果：两组各有2人入选。两组人在出现肾衰时的年龄、Charlson指数、血肌酐、尿量、平均动脉压、血钾、血碳酸氢盐、血白蛋白、C反应蛋白水平均无统计学差异。A组无穿刺出血、导管引流障碍等并发症。从诊断急性肾衰开始A、B组的中位生存时间分别是430、392小时(P = 0.0248)，从SOFA评分大于10开始A、B组的中位生存时间分别是418、323小时(P = 0.0499)，从SOFA评分大于14开始A、B组的中位生存时间分别是227、133 (P = 0.0303)。Cox比例风险分析显示腹透组的死亡风险比为0.397(P = 0.025)。结论：直穿法置管腹透可延长高龄重症急性肾衰患者的生存时间。

Abstract: Objective: To investigate whether acute peritoneal dialysis (PD) with percutaneously placed cath-eter can prolong survival time in aged intensive care patients (ICU) with acute kidney injury (AKI). Methods: Patients who aged over 75, having multiple organ dysfunction with AKI, being treated by acute PD with percutaneously placed catheter, were allocated in group A. Patients in group B were matched in baseline characteristics with group A. Results: The same baseline characteristics, in-cluding age, Charlson score, serum creatinine, urine output, mean arterial pressure, serum potas-sium, serum bicarbonates, serum albumin, CRP level, were noted in each group with 2 patients. Group A had no complications such as puncture bleeding and obstruction of catheter. Median sur-vival time after the diagnosis of AKI in group A and B was 430, 392 hours, respectively (P = 0.0248). Median survival time after SOFA score over 10 in group A and B was 418, 323 hours, respectively (P = 0.0499). Median survival time after SOFA score over 14 in group A and B was 227, 133 hours, respectively (P = 0.025). Conclusion: Acute PD with percutaneously placed catheter can prolong survival time in aged ICU patients with AKI.