急性肾损伤对心搏骤停后综合征患者预后的影响

Impact of Acute Kidney Injury on the Prognosis of Patient with Post-Cardiac Arrest Syndrome

目的:探讨急性肾损伤对心搏骤停后综合征患者预后的影响。方法:搜集重症监护病房心搏骤停后综合征患者37例,根据急性肾损伤诊断标准将其分为急性肾损伤组(AKI组)和非急性肾损伤组(非AKI组),观察两组患者24h、72h和28d存活率及自重症监护病房转出率差异,并使用CPC分级和GCS评分对两组患者72h和28d神经功能预后进行评估。比较两组患者并发5个或以上器官功能障碍比例的差异。结果:37例患者中急性肾损伤患者15例(40.5%),非急性肾损伤患者22例(59.5%)。AKI组24h、72h和28d存活率分别为73.3%、73.3%和13.3%,转出率为13.3%。非AKI组24h、72h和28d存活率分别为95.5%、72.7%和40.9%,转出率为40.9%。两组72h平均CPC分级分别为(3.73±0.19)级和(3.13±0.27)级(P<0.05),平均GCS评分分别为(5.36±1.45)分和(8.53±1.51)分(P<0.05)。两组28d平均CPC分级分别为(2.50±1.50)级和(1.56±0.34)级(P>0.05),平均GCS评分分别为(10.00±5.00)分和(13.78±1.22)分(P>0.05)。两组并发5个或以上器官功能障碍的比例分别为86.7%和45.5%(P<0.05)。结论:急性肾损伤患者24h存活率、28d存活率和自重症监护病房转出率均低于非急性肾损伤患者,72h存活率无差异。急性肾损伤患者72h和28d神经功能预后均较非急性肾损伤患者差。并发急性肾损伤的心搏骤停后综合征患者更易发生其它多个脏器功能障碍。

Objective： To investigate the impact of acute kidney injury （AKI） on the prognosis of patient with post-cardiac arrest syndrome（PCAS）. Methods： Patients with PCAS in ICU were divided in- to two groups （AKI group and Non-AKI group） based on diagnostic criteria of AKI. The survival rates after 24 h, 72 h, 28 d and the rate of discharge from ICU were compared. The neurological recovery was evaluated by using the Pittsburgh cerebral performance category （CPC） and Glas- gow Coma Scale （GCS）. Other organs dysfunction was also analyzed. Results： Of the 37 post- cardiac arrest syndrome patients, 15 suffered from AKI （40. 5%）. The survival rate in AKI group was 73.3%, 73.3%, and 13.3% respectively after 24 h, 48 h, and 28 d, and the rate of discharge from ICU was 13.3%. For non-AKI group, the survival rate was 95.5%, 72.7%, and 40.9% respectively after 24 h, 48 h, and 28 d, and the rate of discharge from ICU was 40.9%. After 72 hours, the average scores of CPC were （3.73±0. 195） and （3.13±0. 274） respectivelyin AKI group and Non-AKI group （P〈0.05）, while the average scores of GCS were （5.36＋1. 448） and （8.53±1. 508） respectively （P〈0.05）. After 28 days, the average of CPC for two groups were （2.50±1.50） and （1.56±0. 338） respectively（P）0.05）, and the average scores of GCS were （10.00±5.00） and （13.78±1. 222） respectively（P〉0.05）. The rates of complicating with five or more other organs dysfunction were 86.7% and 45.5% respectively in AKI group and Non-AKI group （P〈0.05）. Conclusion： The rate of 24 h survival, 28 d survival and the rate of discharge from ICU were lower in AKI group, while there was no difference in the rate of 72 h survival. Neurological recovery was poorer in AKI group. Other organs dysfunction was more likely to happen in patients with PCAS complicated by AKI.