连续性肾脏替代疗法治疗高龄急性肾损伤患者的回顾性研究

A retrospective study on old aged patients with acute kidney injury receiving bed-side continuous renal replacement therapy

目的分析影响床旁连续性肾脏替代疗法(CRRT)治疗高龄急性肾损伤(AKI)患者预后的相关因素,探讨改善疗效的措施。方法对解放军总医院南楼肾科2000年1月～2010年12月因AKI行床旁CRRT的危重高龄患者41例进行回顾性研究。按患者存活与否分为存活组16例和死亡组25例,比较两组累及器官数目及生理学和慢性健康评估Ⅱ(APACHEⅡ)评分等可能影响预后的因素。结果存活16例,死亡25例,总病死率60.98%。所有患者APACHEⅡ评分(27.8±5.6)分,危险系数0.80±0.10;其中存活组(26.56±3.46)分,死亡组(32.36±2.83)分,两组比较,差异有统计学意义(P<0.05)。治疗剂量<25ml/(kg·h)与25～50ml/(kg·h)比较(P=0.222),以及25～50ml/(kg·h)与>50ml/(kg·h)比较(P=0.122),均差异无统计学意义。CRRT患者预后与累及器官数目(r=0.690,P<0.001)和APACHEⅡ评分(r=0.664,P<0.001)相关。logistic回归分析显示,累及器官数目(P=0.024)、APACHEⅡ评分(P=0.048)、机械通气(P=0.030)、低白蛋白血症(P=0.040)是影响床旁血液滤过患者预后的主要危险因素。结论 CRRT高龄患者的转归与累及器官数目、APACHEⅡ评分、机械通气和低白蛋白血症等因素相关。APACHEⅡ评分是开始CRRT治疗时机的重要参考指标,并可以预测患者的死亡风险。

Objective To analysis the related factors which may influence the prognosis of old aged patients with acute kidney injury receiving bed-side continuous renal replacement therapy （CRRT）. Methods We analyzed the 41 old aged patients with acute kidney injury （AKI）receiving CRRT in the geriatric department of nephrology,PLA general hospital from 2001 to 2010, retrospectively. All patients were divided into survived group and non-survived group. The possible risk factors which might influence prognosis were compared between the two groups. Results The total number of qualified patients was 41 ,with an age of 80-100 （88.66±4.76）years old. There were 16 patients alive and 25 patients dead. The total mortality was 60.98%. The mean APACHE Ⅱ was （27.8±5.6）points and risk coefficient was 0.80±0.10; （26.56±3.46）points in survived group and （32.36±2.83）points in non- survived group,the difference between two groups was statistically significant （P〈0.05）. Therapeutic doses lower than 25 ml/（kg.h） were followed by a poorer result,and more than 50 ml/（kg .h）meant much better than lower than 25 ml/（kg.h） （P〈0.05）. The outcomes of the patient were related to number of involved oranges （r=0.690,P〈0.001）and APACHE II score （r=0.664,P〈0.001）. Logistic regression analysis revealed some risk factors relating with outcomes,which were the number of involved oranges （P=-0.024）, APACHE Ⅱ score （P=0.048）,Mechanical ventilation （P=0.030） ,Hypoalbuminemia （P=0.040）. Conclusions The prognosis of old aged patients with AKI receiving CRRT may be correlated to some risk factors, such as the number of involved oranges,APACHE Ⅱ score ,therapeutic doses,mechanical ventilation,low serum albumin and so on. APACHE Ⅱ score is an important reference to the timing of CRRT and may predict the outcomes.