儿童重症监护病房78例体质量≤10 kg连续性肾脏替代治疗患儿的预后因素

Prognosis analysis of continuous renal replacement therapy for patients weighing≤10 kg in pediatric intensive care unit

目的探讨体质量≤10 kg危重症患儿连续性肾脏替代治疗的临床特点以及预后情况。方法回顾性分析2010年1月至2019年12月我院儿童重症医学科的体质量≤10 kg连续性肾脏替代治疗的患儿的临床资料,按临床结局分为存活组(n=38)和非存活组(n=40),分析患者的临床特点及预后因素。结果78例患儿纳入分析,存活组中局部枸橼酸抗凝的比例更高(92.1%vs.70%,P=0.029);CRRT启动时间在存活组的时间更短(以入住PICU到CRRT启动时计算),存活组的中位时间为18.6 h,非存活组的中位时间为66.5 h(P=0.002);CRRT启动时存活组的液体负荷更低(1.9%vs.8.6%,P=0.001)。多因素logistic回归分析结果显示,PRISMⅢ评分、液体负荷、CRRT启动时间>24 h是这一群体患儿预后的危险因素(OR=1.120、1.109、3.912,P<0.05)。结论体质量≤10 kg的患儿群体接受连续性肾脏替代治疗的存活率与液体负荷、PRISMⅢ评分和CRRT启动时间存在一定相关性。

Objective To investigate the clinical characteristics and prognosis of patients weighing≤10 kg in pediatric intensive care unit treated with continuous renal replacement therapy.Methods The patients weighing≤10 kg in pediatric intensive care unit treated from January 2010 to December 2019 were retrospectively analyzed.According to the clinical outcome,the patients were divided into survival group(n=38)and non-survival group(n=40),clinical characteristics and prognosis of patients were analyzed.Results This study included 78 cases,it was found that the proportion of regional citrate anticoagulation in the survival group was higher(92.1%vs.70%,P=0.029);the CRRT initiation time was shorter in the survival group(calculated from the time of PICU admission to CRRT initiation),the median time of the survival group was 18.6 hours,while the median time of the nonsurvival group was 66.5 hours(P=0.002);the fluid overload(FO%)of the survivors was lower when CRRT was initiated(1.9%vs.8.6%,P=0.001).Multivariate logistic regression analysis showed PRISMⅢscore,FO%and CRRT initiation time>24 h were risk factors for the prognosis of patients in this group(OR=1.120,1.109,3.912,P<0.05).Conclusion In our cohort,the prognosis of patients weighing≤10 kg treated with continuous renal replacement therapy was associated with FO%,PRISMⅢscore and CRRT initiation time.