心脏术后行连续性肾脏替代治疗患者死亡危险因素分析

Risk factors of death in patients requiring continuous renal replacement therapy after cardiac surgery

目的探讨心脏手术后行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)患者死亡危险因素,并分析CRRT前后各因素变化。方法回顾性分析心脏术后急性肾功能损伤行CRRT治疗的53例患者(存活组26例,死亡组27例)的临床资料,CRRT治疗方法、行CRRT治疗的各项观察指标及死亡危险因素,并进行统计分析。结果心脏术后行CRRT治疗患者病死率为50.9%(27/53)。两组术前心脏手术史、心胸比率、首次CRRT前平均动脉压、血清HCO3-浓度、术后主动脉内球囊反搏使用、低心排血量综合征、感染、CRRT距离手术时间比较,差异有统计学意义(P<0.05)。Logistic回归分析显示术前心胸比率、CRRT前平均动脉压、血清HCO3-浓度及术后感染为行连续性肾脏替代治疗患者的独立危险因素。行CRRT治疗后血流动力学、肾功能及肺功能等指标较行CRRT治疗前改善。结论CRRT治疗后血流动力学、肾功能及肺功能较前改善。术前心胸比率、CRRT前平均动脉压、血清HCO3-浓度及术后感染是心脏术后急性肾损伤行CRRT治疗的独立危险因素。

Objectives To evaluate the risk factors of death and analyse the changes of the factors after continuous renal replacement therapy （CRRT） in patients requiring CRRT after cardiac surgery. Methods All 53 patients who received CRRT after cardiac surgery between June 2005 and January 2009 were reviewed. All the patients were divided into two groups：survivors group（n=26） and non-survivors group（n=27）. Univariate analysis and multivariable logistic regression were used to identify risk factors of death and paired t test was used to analyse the changes of the factors after CRRT. Results The mortality of patients who required CRRT after cardiac surgery was 50.9% （27 / 53）. There was statistical difference in the following factors between survivors and non-survivors ：previous cardiac surgery,preoperative cardiothoracic ratio,mean arterial blood pressure and bicarbonate before CRRT,requiring intra aortic balloon pump postoperative,low cardiac output syndrome,infection and delay between surgery and CRRT start（P〈0.05）. Multivariable logistic regression had identified the following factors as independent risk factors：preoperative cardiothoracic ratio,mean arterial blood pressure and bicarbonate before CRRT,and postoperative infection. Improvement in hemodynamics,renal and pulmonary function were found after CRRT. Conclusions The hemodynamic status was more stable and the renal and pulmonary function were improved after CRRT. Preoperative cardiothoracic ratio,mean arterial blood pressure and bicarbonate before CRRT,and postoperative infection were the independent risk factors.