危重症患儿急性肾损伤连续性肾脏替代治疗不良预后的影响因素分析

Analysis of influencing factors of adverse prognosis of continuous renal replacement therapy in critically ill children with acute kidney injury

目的分析危重症患儿急性肾损伤连续性肾脏替代治疗(CRRT)不良预后的影响因素。方法回顾性分析2017年1月至2019年12月河北省儿童医院158例危重症患儿急性肾损伤CRRT的临床资料。以研究对象进入儿童重症监护室为观察起点,随访28 d,根据预后分为存活组(105例)和死亡组(53例),分析危重症患儿急性肾损伤CRRT不良预后的影响因素。结果两组脓毒性休克、多器官功能障碍、急性肾损伤分期、入院2 h内血肌酐(Scr)水平、尿量、CRRT前Scr水平、胱抑素C、尿微量白蛋白(MAU)、转铁蛋白(TRU)、α1-微球蛋白(α1-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、估算肾小球滤过率(eGFR)比较,差异有统计学意义(P<0.05)。脓毒性休克、多器官功能障碍、急性肾损伤3期、CRRT前Scr≥300.00μmol/L、胱抑素C≥1.00 mg/L、MAU≥7.00 mg/L、α1-MG≥12.00 mg/L、NAG≥24.00 U/L、APACHEⅡ评分≥20分、尿量<800 ml、eGFR<100 ml/(min·1.73m2)是危重症患儿急性肾损伤CRRT不良预后的危险因素(OR>1,P<0.05)。结论对脓毒性休克、多器官功能障碍、急性肾损伤3期、CRRT前Scr水平≥300.00μmol/L、胱抑素C≥1.00 mg/L、MAU≥7.00 mg/L、α1-MG≥12.00 mg/L、NAG≥24.00 U/L、APACHEⅡ评分≥20分、尿量<800 ml、eGFR<100 ml/(min·1.73m2)的患儿应提高警惕,积极救治,降低危重症急性肾损伤患儿的病死率。

Objective To analyze the influencing factors of adverse prognosis of continuous renal replacement therapy(CRRT)in critically ill children with acute kidney injury.Methods Clinical data of 158 cases with CRRT in critically ill children with acute kidney injury in Hebei Children’s Hospital from January 2017 to December 2019 were retrospectively analyzed.The subjects were followed up for 28 days after entering the pediatric intensive care unit.According to the prognosis,the subjects were divided into the survival group(105 cases)and the death group(53 cases),and the factors affecting the adverse prognosis of CRRT in critically ill children with acute kidney injury were analyzed.Results Septic shock,multiple organ dysfunction,acute kidney injury stage,Serum creatinine(Scr)level at 2 h after admission,urine volume,Scr level before CRRT,cystatin C,microalbuminuria(MAU),transferrin(TRU),α1-microglobulin(α1-MG),N-acetyl-β-D-glucosaminosidase(NAG),acute physiology and chronic health evaluation scoring systemⅡ(APACHEⅡ)score,and estimated glomerular filtration rate(eGFR)between the two groups were compared and the differences were statistically significant(P<0.05).Septic shock,multiple organ dysfunction,acute kidney injury stage three,Scr level before CRRT≥300.00μmol/L,cystatin C≥1.00 mg/L,MAU≥7.00 mg/L,α1-MG≥12.00 mg/L,NAG≥24.00 U/L,APACHEⅡscore≥20 points,urine volume<800 mL,and eGFR<100 mL/(min·1.73m2)were risk factors for adverse prognosis of CRRT in critically ill children with acute kidney injury(OR>1,P<0.05).Conclusion For septic shock,multiple organ dysfunction,acute kidney injury stage three,Scr level before CRRT≥300.00μmol/L,cystatin C≥1.00 mg/L,MAU≥7.00 mg/L,α1-MG≥12.00 mg/L,NAG≥24.00 U/L,APACHEⅡscore≥20 points,urine volume<800 ml,and eGFR<100 ml/(min·1.73m2)of CRRT in critically ill children with acute kidney injury should be vigilant,active treatment,to reduce the fatality rate of critically ill children with acute kidney injury.