| Abstract | Cilj istraživanja: Cilj ovog istraživanja je odrediti demografske i kliničke karakteristike bolesnika liječenih kontinuiranom veno - venskom hemodijalfiltracijom (CVVHDF), kao i incidenciju upotrebe CVVHDF u jedinici intenzivnog liječenja kardiokirurških bolesnika na Klinici za anesteziologiju, reanimatologiju i intenzivno liječenje KBC Split u razdoblju od siječnja 2009. do kraja 2015. godine.
Ispitanici i metode: Retrospektivno su pregledani protokoli liječenja te povijesti bolesti u jedinici intenzivnog liječenja kardiokirurških bolesnika (n=2582) u periodu od siječnja 2009. do kraja 2015. godine u KBC Split. U istraživanje je uključeno 141 bolesnik koji se liječio metodom bubrežnog nadmomjesnog liječenja - kontinuirana veno - venska hemodijafiltracija (CVVHDF). Prvi put ova metoda bubrežnog nadmojesnog liječenja upotrijebljena je u studenom 2009. godini. Analizirani su: dob, spol, osnovna dijagnoza bolesti, hitnoća liječenja, duljina boravka u jedinici kardio JIL-a, dan uključenja na kontinuiranu veno - vensku hemodijafilrtaciju (CVVHDF) te postojanje smrtnog ishoda za sve bolesnike u promatranom vremenskom periodu.
Rezultati: Od ukupnog broja bolesnika (n=2582) njih 141 odnosno 5,46 % je liječeno s kontinuiranom veno - venskom hemodijafiltracijom kao metodom bubrežnog nadomjesnog liječenja. Najveća incidencija upotrebe CVVHDF-a bila je u 2013. godini i iznosila je 9,7%. Bolesnici su u 63% slučaja bili muškarci (njih 89), a po dobi uglavnom prevadavaju osobe starije životne dobi, koja po definiciji Svjetske zdravstvene organizacije obuhvaća raspon godina od 60 do 75. godine. Najčešće dijagnoza koja je bila razlogom boravka u jedinici kardio JIL-a jest koronarna bolest srca. Što se tiče samog operacijskog liječenja - najčešće je izvođena kombinacija CABG operacije i zamjene zalistaka, a 40 bolesnika je imalo hitnu operaciju. Prosječano vrijeme boravka u jedinici intenzivnog liječenja bolesnika koji su se liječili metodom kontinuirane veno - venske hemodijafiltracije iznosi 11,5 dana po bolesniku, dok je za ostale bolesnike, tj. one koji nisu liječeni sa CVVHDF prosječno vrijeme boravka bilo 3,35 dana po bolesniku. Analizirano je još i vrijeme uključivanja bolesnika na CVVHDF - i to je uglavnom odmah po dolasku (35 %) ili tijekom prvog dana boravka (22 %) odnosno drugog dana boravka (22 %). Za sve bolesnike i sve godine analizirana je i stopa smtrnosti koja iznosi visokih 46%.
Zaključci: Akutno bubrežno zatajenje često je u jedinicama intenzivnog liječenja, osobito nakon kardiokirurških operacija. Zahtjeva aktivan pristup, te je bitno na vrijeme uočiti bolesnike sa povećanim rizikom za razvoj bubrežnog zatajenja te što ranije krenuti sa liječenjem kako bi utjecali na pobol i smrtnost takvih bolesnika. U jedinicama intenzivnog liječenja prednost se daje metodama kontinuiranog bubrežnog liječenja, te se njihova upotreba kreće oko 5% godišnje. Preživljenje bolesnika unatoč napretku skrbi i aktivnom pristupu liječenja nije visoko, te na njega utječu brojna stanja kako što su dob, prateće bolesti te težina operacijskog zahvata. Stoga je potrebno je nastaviti daljnja istraživanja na ovom području kako bi se dodatno usavršila tehnika bubrežnog nadomjesnog liječenja. |
| Abstract (english) | Objectives: The main objective of this research is to define demographic and clinical characteristics of the patients treated by the Continuous Venovenous Hemodiafiltration (CVVHDF) as well as the incidence of the usage of CVVHDF at the cardiac surgery in the Intensive Care Unit Department of Anesthesiology, Reanimatology and Intensive Care of the University Hospital Split from January 2009 till the end of 2015.
Patients and methods: Protocols of the treatments at the Intensive Care Unit of the cardiac surgery patients in the Clinical Hospital Centre Split and case - histories were examined retrospectively (n=2582) considering the period between January 2009 and the end of the 2015. One hundred fourty one patients treated with the Renal Replacement Therapy - Continuous Venovenous Hemodiafiltration (CVVHDF) were included in this research. This method of Renal Replacement Therapy was first used in November 2009. In this research the following variables were examined: age, gender, main disease diagnosis, urgency of the medical treatment, length of the stay at the intensive care unit, the time to the beginning of CVVHDF as well as the mortality rate for all the patients in the previously mentioned time period.
Results: From the total number of the patients (n=2582), 141 of them (5,46%) were treated by the Continuous Venovenous Hemodiafiltration as a Renal Replacement Therapy method. The highest incidence of the CVVHDF usage was in 2013 (9,7%). 63% of the patients were male (89 of them). Considering the patients' age, it can be concluded that elder patients mostly dominate. Elder people, following the definition of the World Health Organization, include people from 60 to 75 years old. The diagnosis, which appeared the most often and which was the main reason for the stays at the intensive care unit, was the Coronary Arteries Disease. Considering operation treatment itself, the most often used operation was the combination of the CABG operation and valve replacement and just 40 patients had emergency operations. The average length of stay of the patients treated by the CVVHDF method in the Intensive Care Unit was 11,5 days per patient. For the rest of the patients, who were not treated by the CVVHDF method, the average length of stay was 3,35 days per patient. The time to initiation of the CVVHDF was also examined. It was mostly immediately after admission (35%) or during the first or the second day of the stay in ICU (22%). The mortality rate was also examined for all the patients in mentioned time period and it was 46%.
Conclusions: Acute renal failure is a frequent condition in the Intensive Care Units, especially after cardiac surgery operations. It demands active access and it is very important to notice on time patients who are under the increased risk for the Renal Failure occurrence and to start with the treatment as soon as possible in order to affect lingering illness and reduce mortality rate. In the intensive care units, the priority is given to the Continuous Renal Replacement Therapies whose usage is 5% annual. The rate of the patients' survival, contrary to the medical care improvement and active approach treatment, is not very high. There are a lot of factors that affect this rate of survival, such as: age, other illnesses and surgery severity. Due to that, it is important to continue researching this area in order to improve Renal Replacement Therapy technique. |
