目的 观察重症急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)围术期给予持续肾替代治疗(CRRT)的安全性和有效性.方法 纳入2016年1月至2017年12月在兰州大学第一医院监护中心冠心病重症监护室(CCU)住院的AMI患者945例,进行回顾性分析,并筛选出其中PCI围术期行CRRT患者21例,分析比较AMI患者的基线资料特点,评价CRRT治疗前后心功能、肾功能、肝功能等指标的变化趋势.结果 CRRT治疗后24 h、48 h患者心率比CRRT治疗前有所下降,差异有统计学意义(P=0.038),患者平均收缩压、舒张压与CRRT治疗前比较虽均有轻微下降,但差异均无统计学意义(均P>0.05).CRRT治疗后心功能Killip Ⅰ~Ⅱ级(57.1%,12/21)比CRRT治疗前(23.8%,5/21)有明显改善,差异有统计学意义(P=0.001).CRRT治疗后24 h、48 h尿素氮、肌酸酐、谷草转氨酶、谷丙转氨酶及总胆红素均较CRRT前好转,差异均有统计学意义(P<0.05).结论 重症AMI患者在PCI围术期给予CRRT治疗是安全有效的.%Objective To evaluate the safety and efficacy of continuous renal replacement therapy (CRRT) during percutaneous coronary intervention (PCI) in patients with severe acute myocardial infarction (AMI). Methods A total of 945 patients with AMI who were hospitalized in the CCU of the First Hospital of Lanzhou University from January 2016 to December 2017 were retrospectively analyzed and 21 patients had undergone perioperative CRRT during percutaneous coronary intervention. Baseline clinical characteristics of the AMI patients were evaluated before and after CRRT treatment. The changes in heart function, renal function, liver function and other parameters were evaluated. Results The heart rate of patients receiving CRRT was significantly lower at 24h and 48h after CRRT than that of before treatment (P=0.038). Decrease in mean systolic blood pressure and diastolic blood pressure was observed af ter CRRT treatment without statistical significance (P>0.05). Proportion of patients with Killip class I ~ II heart function increased significantly after CRRT[23.8%(5/21)vs. 57.1%(12/21),P=0.001]. Amelioration in urea nitrogen, creatinine, aspartate aminotransferase, glutamic pyruvic transaminase and total bilirubin were found at 24h and 48h after CRRT treatment compared to pre-CRRT levels (P<0.05). Conclusions Perioperative CRRT is safe and effective for patients with severe AMI.
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