血管活性药物评分对体外膜式氧合辅助下婴幼儿患者急性肾损伤的预测作用

Predictive role of vasoactive-inotropic score on acute kidney injury in pediatric patients with extracorporeal membrane oxygenation

目的回顾婴幼儿患者在体外膜式氧合(ECMO)辅助下发生急性肾功能损伤(AKI)的情况,探索其相关预测因素。方法回顾性分析接受ECMO辅助的婴幼儿患者38例,收集一般临床资料,并对建立ECMO前、辅助循环开始后第1个24 h、以及第2个24 h所用的血管活性药物进行评分,采用Logistic回归筛选AKI的相关因素,并分析相关因素对患者预后的影响。结果辅助循环开始后第2个24 h血管活性药评分对急性肾功能损伤的发生有预测作用(P=0.004),高分值患者发生该并发症的风险显著增高(OR=93.3,95%CI:9.1～1021.2,P=0.000),病死率也显著高于低分值患者(OR=14.9,95%CI:2.6～84.1,P=0.01)。结论血管活性药评分是婴幼儿患者在ECMO治疗中发生AKI的预测指标,ECMO辅助第2天血管活性药评分较高则预示患者预后不良。

Objective To retrospect the acute kidney injury（AKI） events in pediatric patients with extracorporeal membrane oxygenation（ECMO） and to assess the predictive role of relative factors.Methods Thirty-eight consecutive pediatric cardiac patients with ECMO,aged 0 to 6 years,were enrolled in this study and the general data was collected.The vasoactive-inotropic agents were scored before ECMO,in the first 24 hours under ECMO,and in the second 24 hours under ECMO.Logistic regression was used for AKI relevant factors.The impact of AKI relevant factors on patients＇ prognosis was assessed.Results The vasoactive-inotropic agents dosage scores in the second 24hours during ECMO support was significantly associated with AKI（P=0.004）.Those patients with high scores received higher AKI risk with odd ratio of 93.3（95% CI： 9.1-1021.2,P=0.000）,and they also received higher mortality risk with odd ratio of 14.9（95% CI： 2.6-84.1,P=0.01）.Conclusion Vasoactive-inotropic agents score is powerful predictor to high risk of AKI events and high risk of mortality.