接受连续性肾脏替代治疗的重症心衰患者的早期死亡影响因素分析

Factors Influencing Early Death in Patients with Severe Heart Failure Treated by Continuous Renal Replacement Therapy

【目的】分析接受连续性肾脏替代治疗(CRRT)的重症心衰患者早期死亡的影响因素。【方法】观察100例接受CRRT的重症心衰患者治疗28d内病死率,根据是否死亡分为死亡组和存活组。收集患者临床病例资料并分析死亡的影响因素。【结果】100例患者中共46例患者死亡,病死率为46.0%,其中14d内病死率为34.0%(34/100)。死亡组与存活组全身炎症反应综合征(SIRS)比例、脓毒症比例、平均动脉压水平、碱剩余(BE)、急性生理与慢性健康评分(APACHEⅡ)、序贯器官衰竭估计评分(SOFA)、pH、氨基末端脑钠肽(NT-proBNP)水平、开始治疗时间、治疗后达到液体负平衡时间相比较差异有显著性(P<0.05)。多因素回归分析结果显示,SIRS、脓毒症、平均动脉压、pH、开始治疗时间、SOFA评分是患者死亡独立影响因素(P<0.05),合并SIRS、合并脓毒症、平均动脉压≤60mmHg、pH≤7.35、SOFA评分>10分的CRRT重症心衰患者预后较差。【结论】接受CRRT的重症心衰患者28d内死亡的影响因素较多,合并SIRS、合并脓毒症、平均动脉压≤60mmHg、pH≤7.35、SOFA评分>10分、开始治疗时间>24h是患者28d内死亡的危险因素。

【Objective】To analyze the factors affecting early death in patients with severe heart failure with CRRT.【Methods】A total of 100 patients with severe heart failure who underwent CRRT were enrolled.The mortality of patients treated for 28 days was observed.The patients were divided into death group and survival group according to whether they died.Patient clinical case data were collected and the influencing factors of death was analyzed.【Results】Among the 100 patients,46 patients died,with a mortality rate of 46.0%,of which 34.0%(34/100)died within 14 days.Among the death group and the survival group,there were significant differences in the proportion of systemic inflammatory response syndrome(SIRS),sepsis,mean arterial pressure,base excess(BE),acute physiology and chronic health score(APACHEⅡ),sequential organ failure assessment score(SOFA),pH,N-terminal brain natriuretic peptide(NT-proBNP)level,time to start treatment and time to reach negative fluid balance after treatment(P<0.05).Multivariate regression analysis showed that Sirs,Sepsis,mean arterial pressure,pH,start time of treatment,SOFA score were independent influencing factors of death(P<0.05).CRRT patients of severe heart failure with SIRS,Sepsis,mean arterial pressure≤60mmHg,pH≤7.35,SOFA score>10 had poor prognosis.【Conclusion】There are many influencing factors of death within 28 days in patients with severe heart failure receiving CRRT.Patients with SIRS,Sepsis,mean arterial pressure≤60mmHg,pH≤7.35,SOFA score>10,and starting treatment time>24h were risk factors for death within 28d.