重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素

Risk Factors of Renal function Recovery Among Patients of Severe Acute Kidney Injury with Continuous Renal Replacement Therapy

目的:通过研究重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素,为重症急性肾损伤患者的诊治及预后提供科学依据。方法:选取2009年7月至2013年10月本院住院且采用CRRT治疗的284例重症急性肾损伤患者,记录患者的一般资料、APACHEⅡ评分、血液生化指标、伴随症状及肾功能预后情况,将预后情况和各影响因素进行Logistic回归分析得出影响肾功能恢复的影响因素。结果:284例重症急性肾损伤患者中,肾功能恢复有89例(31.33%);肾功能恢复组的年龄、衰竭器官数、APACHEⅡ评分、动脉血二氧化碳分压、合并慢性肾脏病率及合并严重基础疾病率均低于肾功能未恢复组,而平均动脉压和血小板计数高于肾功能未恢复组(P<0.05),两组间合并机械通气率和合并少/无尿率无统计学差异(P>0.05);衰竭器官数、APACHEⅡ评分、合并严重基础疾病及AKI分期为CRRT治疗重症急性肾损伤患者肾功能恢复的危险因素。结论:CRRT治疗重症急性肾损伤的主要危险因素为衰竭器官数、APACHEⅡ评分、合并严重基础疾病及AKI分期。在临床治疗中,应正确评估病情,早期及时采取CRRT治疗,以提高生存率,促进肾脏功能恢复。

Objective： To analyze the risk factors of renal function recovery in patients with the severe acute kidney injury with the method of continuous renal replacement so as to provide a scientific basis to the diagnosis, the treatment and the prognosis of the disease. Methods： Choose 284 patients of severe acute kidney injury who was treated in our hospital from July 2009 to October 2013, recoding each patient＇s general data, APACHE II score, blood biochemical indicators, symptoms and renal function prognosis, then get the risk factors of renal function recovery by Logistic regression analysis of prognosis and factors. Results： Among 284 patients, 89 patients＇ renal function recovered （31.33%）; the age, number of failure organs, APACHE Ⅱ score, arterial blood of CO2 partial pressure, the rate of chronic kidney disease and the rate of severe basic diseases of patients whose renal function recovered are lower than patients whose renal function unrecovered （P〈0.05）, while the rate of mechanical ventilation and little/no urine between two groups have no statistical difference （P〉0.05）. The number of failure organs, APACHE II score, the rate of severe basic diseases and AKI stage are risk factors of renal function recovery among patients of severe acute kidney injury with continuous renal replacement therapy. Conclusions： The risk factors of renal function recovery among patients of severe acute kidney injury with continuous renal replacement therapy are number of failure organs, APACHE Ⅱ score, the rate of severe basic diseases and AKI stage. In the clinical treatment, we should assess the illness correctly and take CRRT treatment early and timely to improve the survival rate and promote the recovery of kidney function.