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目的 观察血液净化联合法舒地尔治疗老年心脏术后急性肾损伤的临床效果.方法 50例老年心脏术后急性肾损伤患者,按随机数字表法分为对照组和研究组,每组25例.均予常规药物治疗及血液净化,研究组在常规药物治疗及血液净化的同时给予法舒地尔注射液30 mg+0.9％氯化钠注射液50 ml静脉泵入,每12h1次,连用7d.观察治疗前后两组患者尿量、尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、尿γ-谷氨酰转移酶(γ-GTP)、尿α1-微球蛋白(α1-MG)、血清肌酐(SCr)、血尿素氮(BUN)及肌酐清除率(CCr)的变化,并计算两组患者急性生理学和慢性健康评估(APACHE)Ⅱ评分.结果 两组治疗前各项指标比较差异均无统计学意义(P＞0.05).研究组治疗后3,5,7d尿量明显多于同期对照组[(38.72±2.68) ml/h比(31.68±2.52) ml/h、(47.24±3.73) ml/h比(40.24±2.52) ml/h、(63.80±2.50) ml/h比(56.60±3.30) ml/h],尿NAG、尿α1-MG、尿γ-GTP、SCr、BUN均明显低于同期对照组[尿NAG:(25.05±5.44) U/L比(28.04±5.21) U/L、(24.06±3.43) U/L比(27.23±6.43) U/L、(22.08±3.25) U/L比(26.23±4.41) U/L;尿α1-MG:(24.05±3.65) mg/L比(26.74±6.74) mg/L、(22.98±3.58) mg/L比(25.57±3.58) mg/L、(20.95±3.78) mg/L比(25.48±3.45) mg/L;尿γ-GTP:(8.2±0.4) U/L比(10.8±3.8) U/L、(7.3±0.2) U/L比(10.5±2.5) U/L、(6.5±1.4) U/L比(9.7±2.6) U/L;SCr:(206.52±6.72)μmol/L比(255.16±6.75)μmol/L、(182.98±6.26)μmol/L比(252.23±9.53)μmol/L,(133.25±7.95)μmol/L比(170.75±7.94)μmol/L;BUN:(19.61±3.23) mmol/L比(20.25±3.25) mmol/L、(16.76±2.06) mmol/L比(18.32±4.84) mmol/L、(12.28±2.26) mmol/L比(14.27±4.54) mmol/L],CCr明显高于同期对照组[(18.66±3.89) ml/min比(13.28±3.25) ml/min、(27.76±4.36) ml/min比(16.23±4.18) ml/min、(33.79±5.58) ml/min比(22.12±4.65) ml/min],差异均有统计学意义(P＜0.05).对照组治疗前及治疗后5,7d APACHEⅡ评分分别为(32.20±4.51)、(26.38±5.28)、(21.43±4.22)分,研究组分别为(33.05±3.82)、(22.15±3.42)、(13.25±2.15)分.两组治疗前APACHEⅡ评分比较差异无统计学意义(P＞0.05),两组治疗后5,7 d APACHEⅡ评分均得到了显著改善,而且研究组显著优于对照组,差异有统计学意义(P＜0.05).结论 采用血液净化联合法舒地尔治疗老年心脏术后急性肾损伤患者临床效果显著,同时安全性高,具有十分重要临床意义.“,”Objective To explore the clinical effect of blood purification combined with fasudil in elderly cardiac surgery patients with postoperative acute kidney injury.Methods Fifty elderly cardiac surgery patients with postoperative acute kidney injury were divided into control group and study group by random digit table method with 25 cases each.The 2 groups were treated with routine drug and blood purification,the study group was additionally given fasudil injection 30 mg + 0.9％ sodium chloride injection 50 ml vein pumping,1 time/12 h,for 7 d.The urine volume,urine N-acetyl-β-D-glucosaminidase (NAG),urine γ-glutamyl transpeptidase (γ-GTP),urine α 1-microglobulin (α 1-MG),serum creatinine (SCr),blood urea nitrogen (BUN) and creatinine clearance rate (CCr) were observed,and the acute physiology and chronic health evaluation (APACHE) Ⅱ score was computed.Results There were no statistical differences in the indexes before treatment between the 2 groups (P＞ 0.05).The urine volume after treatment 3,5,7 d in study group was more than that in control group [(38.72 ± 2.68) ml/h vs.(31.68 ± 2.52) ml/h,(47.24 ±3.73) ml/h vs.(40.24 ± 2.52) ml/h、(63.80 ± 2.50) ml/h vs.(56.60 ± 3.30) ml/h],urine NAG,urine α 1-MG,urine γ-GTP,SCr and BUN were lower than those in control group [NAG:(25.05 ±5.44) U/L vs.(28.04 ± 5.21) U/L,(24.06 ± 3.43) U/L vs.(27.23 ± 6.43) U/L,(22.08 ± 3.25) U/L vs.(26.23 ± 4.41) U/L; α 1-MG:(24.05 ± 3.65) mg/L vs.(26.74 ± 6.74) mg/L,(22.98 ± 3.58) mg/L vs.(25.57 ± 3.58) mg/L,(20.95 ± 3.78) mg/L vs.(25.48 ± 3.45) mg/L; γ-GTP:(8.2 ± 0.4) U/L vs.(10.8 ± 3.8) U/L,(7.3 ± 0.2)U/L vs.(10.5 ± 2.5) U/L,(6.5 ± 1.4) U/L vs.(9.7 ± 2.6) U/L; SCr:(206.52 ± 6.72) μ mol/L vs.(255.16 ±6.75) μmol/L,(182.98 ±6.26) μmol/L vs.(252.23 ±9.53) μmol/L,(33.25 ±7.95) μmol/L vs.(170.75 ± 7.94) μ mol/L; BU N:(19.61 ± 3.23) mmol/L vs.(20.25 ± 3.25) mmol/L,(16.76 ± 2.06) mmol/L vs.(18.32 ± 4.84) mmol/L,(12.28 ± 2.26) mmol/L vs.(14.27 ± 4.54) mmol/L],CCr was higher than that in control group [(18.66 ± 3.89) ml/min vs.(13.28 ± 3.25) ml/min,(27.76 ± 4.36) ml/min vs.(16.23 ± 4.18)ml/min,(33.79 ± 5.58) ml/min vs.(22.12 ± 4.65) ml/min],there were statistical differences (P ＜ 0.05).The APACHE Ⅱ score before treatment and after treatment 5,7 d in control group were (32.20 ±4.51),(26.38 ±5.28) and (21.43 ±4.22) scores,in study group were (33.05 ±3.82),(22.15 ±3.42) and (13.25 ± 2.15) scores.There was no statistical difference in the APACHE Ⅱ score before treatment (P ＞ 0.05),the APACHE Ⅱ score after treatment was improved,furthermore APACHE Ⅱ score after treatment 5,7 d in study group were better than those in control group,there were statistical differences (P ＜ 0.05).Conclusions The treatment effect of blood purification combined with fasudil is remarkable in elderly cardiac surgery patients with postoperative acute kidney injury.At the same time,it has high security and very important clinical significance.