心脏手术后接受连续性肾脏替代治疗的急性肾损伤患者死亡相关危险因素分析

Risk factors of mortality in acute kidney injury patients receiving continuous renal replacement therapy after cardiac surgery

目的探讨心脏手术后需行连续性肾脏替代治疗(CRRT)的急性肾损伤(AKI)患者死亡的相关危险因素。方法选取2007年9月—2013年1月间在上海交通大学医学院附属瑞金医院因心脏手术后发生AKI而接受CRRT的患者78例,男55例,女23例;CRRT采用连续性静脉-静脉血液透析滤过(CVVHDF)模式。以出院转归为依据将患者分入死亡组(44例)和存活组(34例)。记录并比较两组患者的一般资料、心脏手术前后各项生物化学指标水平,以及术前行心脏超声检查评估患者的左心室射血分数(LVEF)。采用多因素Logistic回归分析患者死亡独立相关危险因素。结果两组间年龄、性别构成,高血压、糖尿病、慢性肾脏病、脑血管病和纽约心脏病学会(NYHA)心功能分级、体外循环手术、术中输血的构成比,以及肾小球滤过率估算值(eGFR)、LVEF的差异均无统计学意义(P值均>0.05)。存活组手术至CRRT的时间显著短于死亡组(P<0.05)。死亡组术前的血红蛋白(Hb)、血白蛋白(ALB)、血钙水平均显著高于存活组术前(P值均<0.05),死亡组手术前后Hb和ALB水平差值均显著大于存活组(P值均<0.05)。多因素Logistic回归分析结果显示,术前NYHA心功能分级(OR=3.692)、手术前后ALB水平差值(OR=1.229)均与患者死亡呈独立正相关(P值均<0.05)。结论心脏手术后需行CRRT的AKI患者在住院期间的病死率较高,术前NYHA心功能分级、手术前后ALB水平差值是患者死亡的独立危险因素。

Objective To explore the risk factors of mortality in patients suffering from acute kidney injury （AKI） after cardiac surgery and undergoing continuous renal replacement therapy （CRRT）. Methods A total of 78 patients who suffered from AKI after cardiac surgery and later were treated with continuous veno-venous hemodiafiltration （CVVHDF） in Ruijin Hospital of Shanghai Jiaotong University from September 2007 to January 2013 were enrolled in this study. Among the 78 patients, 55 were males and 23 were females; 44 were dead and 34 were survival while discharging. Demographic data, biochemical data before and after the surgery were collected and analyzed. Left ventricular ejection fraction （LVEF） of each patient was evaluated before the surgery. Logistic regression analysis was applied to analyze independent risk factors of mortality in AKI patients after cardiac surgery. Results There were no significant differences in terms of age, gender, hypertension, diabetes, chronic kidney disease, cerebrovascular disease, New York Heart Association （NYHA） heart function, cardiopulmonary bypass, transfusion during the surgery, estimted glomerular filtration rate （eGFR）, or LVEF between survival group and death group （all P〉0.05）. The interval time between cardiac surgery and CVVHDF of the survival group was significantly shorter than that of death group （P〈0.05）. Preoperative hemoglobin, albumin and calcium levels and postoperative hemoglobin and albumin levels of death group were significantly higher than that of survival group （all P〈0.05）. Difference of both Hb and ALB levels before and after operation in death group was significantly higher than that in survival group （both P〈0. 05）. Multivariate Logistic regression showed that preoperative NHYA heart function （ OR = 3. 692）, the difference of albumin between pre-operation and postoperation （OR= 1. 229） were independently correlated with mortality in AKI patients treated by CRRT after cardiac surgery （both P〈0. 05）. Conclusion The mortality of the inpatients suffering from AKI after cardiac surgery and undergoing CRRT is very high. Preoperative NYHA heart function and the difference of albumin between pre-operation and post-operation are the independent risk factors of mortality.