容量超负荷对心脏术后应用连续性肾脏替代治疗患儿预后的影响

Effect of fluid overload on the prognosis of children receiving continuous renal replacement therapy after cardiac surgery

目的探讨容量超负荷对心脏术后应用连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)患儿预后的影响。方法对2005年6月至2010年6月心脏术后应用CRRT的48例患儿进行分析。患儿从入重症监护病房(intensive care unit,ICU)开始到CRRT前的容量超负荷情况用百分比的形式表达:[总液体入量(L)-总液体出量(L)]/[患儿入ICU时体质量(kg)]×100%。根据容量超负荷程度分为<10%组和≥10%组,对2组患儿的临床资料及预后等情况进行统计分析。结果 48例患儿中有26例(54.2%)容量超负荷<10%,22例(45.8%)≥10%。CRRT开始时容量超负荷≥10%的患儿死亡率明显高于容量超负荷<10%的患儿,分别为63.6%(14/22)和34.6%(9/26),差异有统计学意义(P<0.05)。经多因素logistic回归分析,容量超负荷程度是心脏术后应用CRRT患儿死亡的危险因素(OR=1.05,95%CI=1.02～1.08,P<0.05)。结论心脏术后应用CRRT患儿的容量超负荷严重程度与预后存在相关性,可影响患儿预后,故加强CRRT开始前容量负荷的管理可能对改善预后起到一定的作用。

Objective To evaluate the effect of fluid overload on the prognosis of children receiving continuous renal replacement therapy（CRRT） after cardiac surgery.Methods We collected 48 children receiving CRRT after cardiac operation from June 2005 to June 2010.Fluid overload in the period from admission to ICU to initiation of CRRT was expressed as：[total fluid intake（L） ？total fluid output（L）] /[body weight at admission to ICU（kg）] x 100%.The patients were divided into two groups：fluid overload 10% group and fluid overload ≥10% group.Their clinical manifestations and outcomes were recorded and analyzed.Results In the 48 cases,26 cases（54.2%） were found to have fluid overload 10%,and 22 cases（45.8%） to have fluid overload ≥10%.The mortality rate was significantly higher in children with fluid overload ≥10%（14/22;63.6%） than in those with fluid overload 10%（9/26;34.6%）.Multivariate logistic regression analysis demonstrated that the degree of fluid overload was significantly correlated with the mortality rate（OR=1.05;95% CI=1.02-1.08）.Conclusions The prognosis of the children receiving CRRT after cardiac surgery correlates to the degree of fluid overload.Appropriate fluid management before CRRT may improve the prognosis.