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目的 评价连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)对StanfordA型主动脉夹层术后急性肾损伤的疗效.方法 回顾性分析2003年1月至2014年1月于福建医科大学附属协和医院心脏外科行手术治疗后出现急性肾损伤并进行血液透析的58例Stanford A型主动脉夹层患者的临床资料.按透析方式将患者分为CRRT组和床旁间歇性血液透析(intermittent hemodialysis,IHD)组.CRRT组38例,其中男29例、女9例,平均年龄(49.8±13.7)岁.IHD组20例,其中男14例、女6例,平均年龄(52.6±11.0)岁.结果 两组患者平均手术时间差异无统计学意义(P=0.367),而住ICU时间(P=0.006)、住院时间(P=0.047)、透析次数(P=0.001)和透析治疗时间(P=0.039)差异有统计学意义,CRRT组指标更优.CRRT组和IHD组并发症主要为血压下降(P=0.027)和急性充血性心力衰竭(P=0.011)发生率差异有统计学意义,CRRT组发生率更低.两组死亡(P=0.544)和痊愈(P=0.056)差异无统计学意义.与IHD相比,CRRT对降低简化急性生理状态评分系统(SAPS)Ⅱ评分的作用更大且差异有统计学意义(时间F=60.964,P=0.000,时间*分组F=3.178,P=0.014),而降低急性肾小管坏死个体病情严重性指数(ATN-ISI)评分差异无统计学意义(时间F=13.803,P=0.000,时间*分组F=0.222,P=0.951).结论 相比IHD,CRRT能在较短时间内改善Stanford A型主动脉夹层术后AKI患者的病情,且透析相关并发症发生率较低.“,”Objective To evaluate the efficacy of the continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) after the surgery of type A aortic dissection.Methods We retrospectively analyzed 58 hemodialysis patients with AKI after type A aortic dissection surgery in our hospital between January 2003 and January 2014.The 58 patients were divided into two groups including a bedside intermittent hemodialysis (IHD) group and a CRRT group based on the methods of hemodialysis.There were 38 patients with 29 males and 9 females at average age of 49.8±13.7 years in the CRRT group.There were 20 patients in the IHD group with 14 males and 6 females at average age of 52.6± 11.0 years.Results Compared with IHD,CRRT had significantly greater effect on reducing the simplified acute physiology scoring system (SAPS) Ⅱ score (Ftime=60.964,P=0.000;Ftime* vOup=3.178,P=0.041).However,there was no significant difference in reducing the acute tubular necrosis individual illness severity index (ATN-ISI) score between the two groups (Ftitime=13.803,P=0.000;Ftime* group=0.222,P=0.951).Lower incidences of dialysis-related complications including hypotension (P=0.027) and acute congestive heart failure (P=0.011) were found in the CRRT group.There was no statistical difference in operation time (P=0.367) between the two groups.While statistical differences in duration of hospitalization in intensive care unit (P=0.006),in hospital time (P=0.047),frequency of dialysis (P=0.001),and dialysis time (P=0.039) were found between the two groups.However there were no significant differences in mortality during hospital (P=0.544)and incidences of recovery (P=0.056) between the two groups.Conclusion Compared with IHD,CRRT had significantly positive effect on patients who suffered from AKI after type A aortic dissection surgery,which can help reduce incidences of dialysis-related complications,duration and cost of hospitalization in ICU.