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JAMA:阿司匹林或可乐定不能降低围术期急性肾损伤风险

2014-12-05 黄宗顺 丁香园

急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,常导致不良的预后和带来昂贵的医疗负担。以往的一些研究结果提示在围手术期服用阿司匹林或可乐定可降低AKI发生的风险。 然而,事实是否如此仍然未确定,并且围手术期运用这两种药物进行干预都有潜在的危害。为此,来自加拿大伦敦健康科学中心的Amit博士等引领全球多中心开展了一个庞大的临床随机试验。该试验的研究成果于今年11月

急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,常导致不良的预后和带来昂贵的医疗负担。以往的一些研究结果提示在围手术期服用阿司匹林或可乐定可降低AKI发生的风险。

然而,事实是否如此仍然未确定,并且围手术期运用这两种药物进行干预都有潜在的危害。为此,来自加拿大伦敦健康科学中心的Amit博士等引领全球多中心开展了一个庞大的临床随机试验。该试验的研究成果于今年11月发表在Journal of the American Medical Association上。

研究采用2X2析因分析、随机、盲法的临床试验,纳入了来自于全球22个国家88个医学研究中心在2011年1月至2013年12月先后入院接受非心脏手术的6905位患者。

被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂。

此研究的具体纳入标准、分组、随访和分析见图1。

figure1.bmp
图1 研究纳入标准和随访流程图。该试验在POISE-2(围手术期缺血评估试验2)临床试验的基础上,严格筛选,排除组间年龄、性别、手术前服药、地区、疾病、eGFR等混杂因素,总共纳入了2011年1月至2013年12月来自22个国家88个研究中心的6905位患者。盲法下将受试者随机分配至可乐定安慰剂与阿司匹林组(1725例)、阿司匹林安慰剂与可乐定组(1735例)、双药的安慰剂组(1727例)、阿司匹林和可乐定组(1718例)。

研究依血清肌酐浓度较术前升高程度将AKI定义为:术后48小时以内升高0.3mg/dl(26.5umol/L)以上或在术后七天以内升高50%以上。

结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。

类似的,可乐定增加了临床显著性低血压发生的风险,分析也提示临床上显著性的低血压更容易产生继发性的AKI。

综上所述,该大型研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。

原始出处

Garg AX1, Kurz A2, Sessler DI2, Cuerden M1, Robinson A3, Mrkobrada M1, Parikh CR4, Mizera R3, Jones PM1, Tiboni M3, Font A5, Cegarra V5, Gomez MF6, Meyhoff CS7.et.al.Perioperative aspirin and clonidine and risk of acute kidney injury: a randomized clinical trial.JAMA. 2014 Dec 3

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    2015-07-31 sundong

    原来不能用阿司匹林啊

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1683406, encodeId=9982168340612, content=<a href='/topic/show?id=a27838412cd' target=_blank style='color:#2F92EE;'>#可乐定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38412, encryptionId=a27838412cd, topicName=可乐定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=217127964539, createdName=vera_1212, createdTime=Wed Feb 11 02:59:00 CST 2015, time=2015-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33929, encodeId=34f03392907, content=原来不能用阿司匹林啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Fri Jul 31 17:16:00 CST 2015, time=2015-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20276, encodeId=bcd7202e6e3, content=AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 22:27:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13167, encodeId=bff81316e9d, content=这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=182.18.110.18, createdTime=Tue Dec 16 18:13:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13158, encodeId=aff2131581f, content=被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=152, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:51:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13157, encodeId=d3121315e97, content=急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:50:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1275365, encodeId=b2e312e53657f, content=<a href='/topic/show?id=6a39406551e' target=_blank style='color:#2F92EE;'>#围术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40655, encryptionId=6a39406551e, topicName=围术期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fca128, createdName=licz0423, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396884, encodeId=0dd8139688411, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1569573, encodeId=73c715695e36f, content=<a href='/topic/show?id=436d3841186' target=_blank style='color:#2F92EE;'>#可乐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38411, encryptionId=436d3841186, topicName=可乐)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eede15532060, createdName=by2014, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=)]
    2015-04-11 x35042875

    AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1683406, encodeId=9982168340612, content=<a href='/topic/show?id=a27838412cd' target=_blank style='color:#2F92EE;'>#可乐定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38412, encryptionId=a27838412cd, topicName=可乐定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=217127964539, createdName=vera_1212, createdTime=Wed Feb 11 02:59:00 CST 2015, time=2015-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33929, encodeId=34f03392907, content=原来不能用阿司匹林啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Fri Jul 31 17:16:00 CST 2015, time=2015-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20276, encodeId=bcd7202e6e3, content=AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 22:27:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13167, encodeId=bff81316e9d, content=这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=182.18.110.18, createdTime=Tue Dec 16 18:13:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13158, encodeId=aff2131581f, content=被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=152, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:51:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13157, encodeId=d3121315e97, content=急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:50:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1275365, encodeId=b2e312e53657f, content=<a href='/topic/show?id=6a39406551e' target=_blank style='color:#2F92EE;'>#围术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40655, encryptionId=6a39406551e, topicName=围术期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fca128, createdName=licz0423, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396884, encodeId=0dd8139688411, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1569573, encodeId=73c715695e36f, content=<a href='/topic/show?id=436d3841186' target=_blank style='color:#2F92EE;'>#可乐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38411, encryptionId=436d3841186, topicName=可乐)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eede15532060, createdName=by2014, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=)]
    2014-12-16 182.18.110.18

    这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1683406, encodeId=9982168340612, content=<a href='/topic/show?id=a27838412cd' target=_blank style='color:#2F92EE;'>#可乐定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38412, encryptionId=a27838412cd, topicName=可乐定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=217127964539, createdName=vera_1212, createdTime=Wed Feb 11 02:59:00 CST 2015, time=2015-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33929, encodeId=34f03392907, content=原来不能用阿司匹林啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Fri Jul 31 17:16:00 CST 2015, time=2015-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20276, encodeId=bcd7202e6e3, content=AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 22:27:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13167, encodeId=bff81316e9d, content=这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=182.18.110.18, createdTime=Tue Dec 16 18:13:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13158, encodeId=aff2131581f, content=被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=152, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:51:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13157, encodeId=d3121315e97, content=急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:50:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1275365, encodeId=b2e312e53657f, content=<a href='/topic/show?id=6a39406551e' target=_blank style='color:#2F92EE;'>#围术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40655, encryptionId=6a39406551e, topicName=围术期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fca128, createdName=licz0423, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396884, encodeId=0dd8139688411, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1569573, encodeId=73c715695e36f, content=<a href='/topic/show?id=436d3841186' target=_blank style='color:#2F92EE;'>#可乐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38411, encryptionId=436d3841186, topicName=可乐)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eede15532060, createdName=by2014, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=)]
    2014-12-16 cbp

    被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。

    0

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    2014-12-16 cbp

    急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1683406, encodeId=9982168340612, content=<a href='/topic/show?id=a27838412cd' target=_blank style='color:#2F92EE;'>#可乐定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38412, encryptionId=a27838412cd, topicName=可乐定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=217127964539, createdName=vera_1212, createdTime=Wed Feb 11 02:59:00 CST 2015, time=2015-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33929, encodeId=34f03392907, content=原来不能用阿司匹林啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Fri Jul 31 17:16:00 CST 2015, time=2015-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20276, encodeId=bcd7202e6e3, content=AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 22:27:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13167, encodeId=bff81316e9d, content=这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=182.18.110.18, createdTime=Tue Dec 16 18:13:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13158, encodeId=aff2131581f, content=被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=152, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:51:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13157, encodeId=d3121315e97, content=急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:50:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1275365, encodeId=b2e312e53657f, content=<a href='/topic/show?id=6a39406551e' target=_blank style='color:#2F92EE;'>#围术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40655, encryptionId=6a39406551e, topicName=围术期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fca128, createdName=licz0423, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396884, encodeId=0dd8139688411, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1569573, encodeId=73c715695e36f, content=<a href='/topic/show?id=436d3841186' target=_blank style='color:#2F92EE;'>#可乐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38411, encryptionId=436d3841186, topicName=可乐)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eede15532060, createdName=by2014, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1683406, encodeId=9982168340612, content=<a href='/topic/show?id=a27838412cd' target=_blank style='color:#2F92EE;'>#可乐定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38412, encryptionId=a27838412cd, topicName=可乐定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=217127964539, createdName=vera_1212, createdTime=Wed Feb 11 02:59:00 CST 2015, time=2015-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33929, encodeId=34f03392907, content=原来不能用阿司匹林啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Fri Jul 31 17:16:00 CST 2015, time=2015-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20276, encodeId=bcd7202e6e3, content=AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 22:27:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13167, encodeId=bff81316e9d, content=这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=182.18.110.18, createdTime=Tue Dec 16 18:13:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13158, encodeId=aff2131581f, content=被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=152, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:51:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13157, encodeId=d3121315e97, content=急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:50:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1275365, encodeId=b2e312e53657f, content=<a href='/topic/show?id=6a39406551e' target=_blank style='color:#2F92EE;'>#围术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40655, encryptionId=6a39406551e, topicName=围术期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fca128, createdName=licz0423, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396884, encodeId=0dd8139688411, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1569573, encodeId=73c715695e36f, content=<a href='/topic/show?id=436d3841186' target=_blank style='color:#2F92EE;'>#可乐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38411, encryptionId=436d3841186, topicName=可乐)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eede15532060, createdName=by2014, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=)]
  9. [GetPortalCommentsPageByObjectIdResponse(id=1683406, encodeId=9982168340612, content=<a href='/topic/show?id=a27838412cd' target=_blank style='color:#2F92EE;'>#可乐定#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38412, encryptionId=a27838412cd, topicName=可乐定)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=217127964539, createdName=vera_1212, createdTime=Wed Feb 11 02:59:00 CST 2015, time=2015-02-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=33929, encodeId=34f03392907, content=原来不能用阿司匹林啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3ykRSkuxjt93yc9tvDWfIQItrwiaKSCps5kyrTyDlwic2FgoCWe88wR3ZiaggKYGueDIp26zVgnbzriaQ/0, createdBy=89d71602869, createdName=sundong, createdTime=Fri Jul 31 17:16:00 CST 2015, time=2015-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20276, encodeId=bcd7202e6e3, content=AKI对心衰临床治疗意义重大,但依然需要研究检验其适用性, beContent=null, objectType=article, channel=null, level=null, likeNumber=162, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sat Apr 11 22:27:00 CST 2015, time=2015-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13167, encodeId=bff81316e9d, content=这个研究否定了阿司匹林的作用,但是未来高剂量的强效他汀,可以考虑对AKI预防中的应用。但这个研究也提醒临床,不能凭经验用药,很多临床经验往往是错误的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=182.18.110.18, createdTime=Tue Dec 16 18:13:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13158, encodeId=aff2131581f, content=被纳入的患者在手术前2~4小时服用200mg阿司匹林或安慰剂,术后30天内每天服用100mg阿司匹林或安慰剂;手术前2~4小时口服0.2mg可乐定或安慰剂,术后72小时内使用可乐定透皮贴剂(含可乐定0.2mg/d)或安慰贴剂,结果显示对比安慰剂,阿司匹林和可乐定都没有改变AKI的发生风险;阿司匹林却提高了大出血的风险,分析还提示大出血更容易产生继发性的AKI。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=152, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:51:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=13157, encodeId=d3121315e97, content=急性肾损伤(Acute kidney injury, AKI)是手术的常见并发症,研究指出在接受非心脏手术的患者中,使用阿司匹林或可乐定都不能降低围手术期AKI发生的风险,这很好地纠正了以往的错误的治疗认知,但同时也使预防围手术期AKI的发生陷入了困境。 <br> <br> , beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=809381710, createdName=cbp, createdTime=Tue Dec 16 16:50:00 CST 2014, time=2014-12-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1275365, encodeId=b2e312e53657f, content=<a href='/topic/show?id=6a39406551e' target=_blank style='color:#2F92EE;'>#围术期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40655, encryptionId=6a39406551e, topicName=围术期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5fca128, createdName=licz0423, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1396884, encodeId=0dd8139688411, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1569573, encodeId=73c715695e36f, content=<a href='/topic/show?id=436d3841186' target=_blank style='color:#2F92EE;'>#可乐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38411, encryptionId=436d3841186, topicName=可乐)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eede15532060, createdName=by2014, createdTime=Sun Dec 07 06:59:00 CST 2014, time=2014-12-07, status=1, ipAttribution=)]
    2014-12-07 by2014

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