体外膜肺氧合患者肾脏替代治疗的预测因素分析

Predictive factors of renal replacement therapy in patients with extracorporeal membrane oxygenation

目的:探讨体外膜肺氧合(Extracorporeal membrane oxygenation,ECMO)患者肾脏替代治疗(Renal replacement therapy,RRT)的预测因素。方法回顾性分析2015年1月至2018年12月江苏省人民医院急诊中心68位ECMO患者的临床资料。以血管活性药物评分(Vasoactiveinotropic score,VIS)评估ECMO治疗第1、2、3天血管活性药物的使用情况(24hVIS、48hVIS、72hVIS)。按照是否RRT分为RRT组和非RRT组,比较年龄、性别、体质量、VIS,ECMO前有无心搏骤停、ECMO模式、ECMO治疗时间等因素,通过Logistic回归分析筛选能够预测ECMO患者是否需要RRT的因素。结果73.5%的ECMO患者接受RRT,RRT组的平均年龄、24hVIS、ECMO下机失败及死亡率均显著高于非RRT组(P<0.05)。高年龄(>临界年龄38.5岁)的ECMO患者RRT使用率高达87.8%。根据24hVIS的临界值(33.75)分为高VIS组和低VIS组,高VIS组的RRT使用率和死亡率均超过90%,显著高于低VIS组(P<0.05)。Logistic回归分析显示年龄(OR 1.223)和24hVIS(OR 1.033)是ECMO患者RRT的预测因素(P<0.05)。结论年龄和24hVIS对ECMO患者是否需要RRT具有一定的预测价值。

Objective To explore the predictive factors of renal replacement therapy(RRT)in extracorporeal membrane oxygenation(ECMO)patients.Methods The clinical data of 68 ECMO patients treated at Emergence Department of Jiangsu Provincial Hospital from January 2015 to December 2018 were retrospectively analyzed.Vasoactive-inotropic score(VIS)was used to assess the usage of vasoactive-inotropic drugs on day 1,2 and 3 of ECMO(24 h VIS,48 h VIS,and 72h VIS).According to received RRT or not,patients were divided into the RRT group and non-RRT group.Age,gender,weight,VIS,presence of cardiac arrest before ECMO,ECMO mode,and ECMO treatment time were compared.Logistic regression analysis was used to identify predictive factors for RRT in ECMO patients.Results Of the enrolled patients,73.5% of ECMO patients received RRT.The mean age,24h VIS,ECMO failure and mortality of the RRT group were significantly higher than those of the non-RRT group(P<0.05).The use of RRT was 87.8% in elderly ECMO patients(>cutoff age of 38.5 years).According to the cutoff value of 24h VIS(33.75),ECMO patients were divided into the high VIS group and low VIS group.The rates of RRT and mortality were both exceeded 90%in the high VIS group,which was significantly higher than that of the low VIS group(P<0.05).Logistic regression analysis showed that age(OR=1.223)and 24h VIS(OR=1.033)were predictive factors of RRT in ECMO patients(P<0.05).Conclusions Age and 24 h VIS show the predictive value for RRT in ECMO patients.