心脏外科术后急性肾损伤行日间连续性肾脏替代治疗死亡危险因素分析

Risk factors of death in patients requiring day-time continuous renal replacement therapy for acute kidney injury after cardiac surgery

目的研究心脏术后急性肾损伤(acute kidney injury,AKI)行日间连续性肾脏替代治疗(daytime continuous renal replacement therapy,DCRRT)患者的死亡危险因素,并分析治疗前后各指标的变化。方法回顾性分析中国医科大学附属第一医院2004年6月至2015年9月期间心脏外科收治的心脏术后AKI行DCRRT治疗的42例患者的临床资料、治疗方法、治疗前后的各项指标及死亡危险因素,并进行统计学分析。结果心脏术后AKI行DCRRT患者的病死率为47.6%(20/42)。存活组与死亡组两组低心排血综合征、年龄等比较差异有统计学意义(P<0.05),治疗前后心率、肾功能等比较差异有统计学意义(P<0.01)。Logistic回归分析显示,首次DCRRT治疗前平均动脉压、血清HCO3-浓度为独立保护性因素。结论 DCRRT治疗后肾功等指标较治疗前有明显改善。DCRRT前平均动脉压、血清HCO3-浓度为心脏术后AKI患者行DCRRT的独立保护性因素。

Objective To study the risk factors of death and analyze the changes of the factors after day-time continuous renal replacement therapy（DCRRT） in AKI patients requiring DCRRT after cardiac surgery. Methods We reviewed the clinical data of the 42 AKI patients who received DCRRT after cardiac surgery in cardiovascular surgery of the First Affiliated Hospital of China Medical University, and divided them into two groups： survivors group（n=22）and non-survivors group（n=20）. Univariate analysis and multivariable logistic regression were used to identify risk factors of death and we used paired t test to analyze the changes of the factors after DCRRT. Results The fatality ratio of patients who reqnired DCRRT after cardiac surgery was 47.6% （20/42）.There was statistical difference in the following factors between survivors and non-survivors： low cardiac output syndrome, age, the time of CPB, etc（P〈0.05）. There was also statistical difference in the heart rate, mean arterial pressure, renal function and so on（P〈0.01）. Multivariable logistic regression had identified the following factors as independent risk factors： mean arterial blood pressure and the density of bicarbonate in blood serum before DCRRT. Obvious improvements in homodynamic and renal function were found after DCRRT. Conclusion The renal function is improved and the homodynamic status is more stable after DCRRT. Mean arterial blood pressure and the density of bicarbonate in blood serum before DCRRT are the independent protective factors.