急性肾损伤连续性肾脏替代治疗后肾功能恢复的影响因素

The risk factors of renal function recovery with continuous renal replacement therapy in acute kidney injury patients

目的分析急性肾损伤(AKI)病人经连续性肾脏替代治疗(CRRT)后肾功能恢复的影响因素。方法选取皖南医学院第二附属医院2013年1月至2017年12月收治的50例接受CRRT治疗的AKI病人为研究对象,依据肾功能是否恢复分为肾功能恢复组和肾功能未恢复组。采用系统性回顾法分析AKI的病因,多因素logistic回归分析法对数据进行对比、分析,探讨CRRT与肾功能恢复的关系。结果在导致AKI的病因中,主要是感染56%(28/50)和休克30%(15/50)。AKI病人经CRRT治疗后,肾功能恢复组的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分[(21.86±4.57)分比(28.82±5.69)分]、器官衰竭数目[(2.91±0.75)个比(4.21±1.82)个]、有严重基础性疾病比率(22.73%比67.86%)、机械通气比率、血管活性药物应用比率、少或无尿比率、有慢性肾脏病比率、血白细胞计数均少于肾功能未恢复组,血小板计数、血红蛋白浓度、血清白蛋白浓度及CRRT介入时期更早的比率[(22.73%,50.00%,27.27%)比(3.57%,32.14%,64.28%)]均大于肾功能未恢复组,均差异有统计学意义(P<0.05)。logistic回归分析结果提示,APACHEⅡ评分(OR=1.464,95%CI:1.227~2.988)、器官衰竭数目(OR=2.351,95%CI:1.688~3.291)、有严重基础性疾病(OR=3.373,95%CI:2.320~9.931)及CRRT治疗介入时期(OR=3.373,95%CI:1.981~8.377)为AKI病人经CRRT治疗后肾功能恢复的影响因素。结论感染是AKI的主要病因,而APACHEⅡ评分、器官衰竭数目、有严重基础性疾病及CRRT治疗介入时期等多种因素共同影响着肾功能的恢复。

Objective To analyze the influencing factors of renal function recovery in patients with acute kidney injury(AKI)with continuous renal replacement therapy(CRRT).Methods A total of 50 patients with AKI who treated with CRRT in The Second Affiliated Hospital of Wannan Medical College from January 2013 to December 2017 were enrolled in the study.The patients were assigned into two groups: renal function recovery group and unrestored renal function group,according to whether renal function was restored.The etiology of AKI was analyzed by systematic review.The data were compared and analyzed by multi-factor logistic regression analysis to explore the relationship between CRRT with renal function recovery.Results The infections and shock were major cause of AKI,which were 56%(28/50)and 30%(15/50),respectively.AKI patients were treated with CRRT,APACHE Ⅱ score[(21.86±4.57)vs.(28.82±5.69)],number of organ failure[(2.91±0.75)vs.(4.21±1.82)],mechanical ventilation ratio,vasoactive drug application ratio,less or no urine ratio,proportion of chronic kidney disease,proportion of severe basic diseases(22.73% vs. 67.86%),the white blood cells counts in renal function recovery group were less than those in the unrecovered renal function group.The platelet count,hemoglobin concentration,serum albumin concentration and the earlier proportion of CRRT in renal function recovery group[(22.73%,50.00%,27.27%)vs.(3.57%,32.14%,64.28%)]were higher than those in the unrecovered renal function recovery,and the differences were statistically significant(P<0.05). Logistic regression analysis showed that APACHE Ⅱ score(OR=1.464,95%CI:1.227-2.988),number of organ failure(OR=2.351,95%CI:1.688-3.291),severe underlying disease(OR=3.373,95%CI:2.320-9.931)and CRRT intervention(OR=3.373,95%CI:1.981-8.377)were the risk factors of renal function recovery in patients with AKI with CRRT therapy.Conclusion Infection is the main cause of AKI,and many factors including and APACHE Ⅱ score,number of organ failure,severe underlying disease and CRRT treatment intervention affect the recovery of renal function.