行连续性肾脏替代治疗的Ⅰ型心肾综合征患者的临床分析

Clinical analysis of continuous renal replacement therapy for cardiorenal syndrome type Ⅰ

目的 分析行连续性肾脏替代治疗（CRRT）的Ⅰ型心肾综合征（CRS）患者的临床特征及其预后。方法选择2009年2月—2014年9月在上海交通大学附属第六人民医院行CRRT的Ⅰ型CRS住院患者35例,男25例,女10例,年龄29-87岁,平均年龄为（69.2±15.3）岁。根据出院时患者存活或死亡,将其分为存活组（17例）和死亡组（18例）。比较两组患者的一般资料、行CRRT前的一般资料和血液学指标,以及治疗情况。采用单因素Logistic回归分析预后相关因素。结果 死亡组患者的年龄、器官衰竭数目、急性生理功能与慢性健康状况评分（APACHEⅡ评分）、应用升压药物的患者构成比,以及平均血小板体积（MPV）、血尿素氮（BUN）和空腹血糖（FBG）水平均显著高于存活组（P值分别〈0.05、0.01）。死亡组的纽约心脏学会（NYHA）心功能Ⅲ/Ⅳ级患者构成比和平均动脉压均显著低于存活组（P值分别〈0.05、0.01）。单因素Logistic回归分析结果显示,行CRRT的CRS患者的预后与其年龄（OR=1.054,95%CI为0.999-1.112）、NYHA心功能分级（OR=11.900,95%CI为1.272-111.351）、器官衰竭数目（OR=3.379,95%CI为1.373-8.318）、APACHEⅡ评分（OR=1.418,95%CI为1.141-1.762）、平均动脉压（OR=0.875,95%CI为0.799-0.959）、MPV（OR=1.789,95%CI为1.066-3.004）、BUN（OR=1.069,95%CI为1.004-1.138）、FBG（OR=1.336,95%CI为0.997-1.791）和应用升压药物（OR=0.529,95%CI为0.338-0.829）均相关（P值均〈0.05）。结论 Ⅰ型CRS患者行CRRT的预后较差,与患者的年龄、NYHA心功能分级、器官衰竭数目、APACHEⅡ评分、平均动脉压、MPV、BUN和FBG水平,以及应用升压药物有关,应引起足够重视。

Objective To analyze clinical features and prognosis of continuous renal replacement therapy （CRRT） for patients with cardiorenal syndrome type I （type I CRS）. Methods A total of 35 type I CRS patients undergoing CRRT in the Sixth People＇s Hospital of Shanghai Jiaotong University from February 2009 to September 2014 were recruited in this study. There were 25 males and 10 females with an average age of （69.2 ± 15. 3） years （range, 29- 87 years）. There were 17 survivors and 18 deaths while discharging. Clinical data of all patients were retrospectively analyzed. Baseline characteristics, clinical and hematological parameters before and after CRRT were compared between survival group and death group. Prognostic factors were analyzed by univariate Logistic analysis. Results Age, failed organs, acute physiology function and chronic health evaluation （APACHE） Ⅱ score, the proportion of usage of pressor agents, mean platelet volume （MPV）, blood urea nitrogen （BUN） and fasting blood glucose （FBG） in the death group were significantly higher than those in the survival group （ P〈0. 05, 0.01）. Whereas, the proportion of New York heart association （NYHA） cardiac function grading Ⅲ/Ⅳ and mean arterial pressure （MAP） in the death group were significantly lower than those in the survival group （P〈 0.05, 0.01）. Univariate Logistic analysis showed that age （OR = 1. 054, 95% C/： 0. 999- 1. 112）, NYHA cardiac function grading （ OR = 11. 900, 95 % OI ： 1. 272- 111. 351 ）, failed organs （OR = 3. 379, 95 % CI ： 1. 373 -8.318）, APACHE Ⅱ scores （OR=1.418, 95%C1： 1. 141-1.762）, MAP （OR=0.875, 95%CI： 0.799- 0.959）, MPV （OR=l.7Bg, 95%01： 1.066-~.004）, BUN f. OR=l.069, 95%01： 1. 004-1.138）, FBG （ OR - 1. 336, 95 % CI ： 0. 997 - 1.791 ） and application of vasopressors （ OR = 0. 529, 95 % CI ： 0. 338 - 0. 829） were significantly associated with the prognosis of type 1 ORS in patients receiving CRRT （all P 〈 0. 05）. Conclusion The prognosis of CRRT in patients with type I ORS is poor. The risk factors include patients＇ age, NYHA cardiac function grading, the number of failed organs, APACHE Ⅱ score, MAP, MPV, BUN, FBG and use of pressor agents.