CRRT时液体负荷状态对脓毒症并发急性肾损伤患者预后的影响分析

Analysis of the effect of fluid load during CRRT on the prognosis of patients with sepsis complicated with acute kidney injury

目的探讨连续性肾脏替代治疗(CRRT)时液体负荷状态对脓毒症并发急性肾损伤(SAKI)患者的预后影响。方法选取2019年1月~2021年12月贺州广济医院118例行CRRT的SAKI患者,比较其基线资料和临床资料,采用logistic回归模型分析影响SAKI患者预后的危险因素,以Kaplan-Meier生存曲线分析SAKI患者行CRRT后30 d内的生存情况。结果118例SAKI患者在CRRT启动后30 d的死亡率为37.29%(44/118)。年龄、液体超负荷(FO)、液体正平衡量、从确诊至行CRRT时间、CRRT总时间、尿量、序贯器官衰竭(SOFA)评分和急性生理与慢性健康状况评分(APACHEⅡ)是CRRT启动后30 d内SAKI患者死亡的主要因素,其中FO、SOFA评分和液体正平衡量是的独立危险因素(OR>1,P<0.05);Kaplan-Meier生存曲线结果显示,FO≥10%和FO<10%累计生存率分别为44.20%和77.30%,整体平均生存率为62.70%,且FO≥10%的患者在CRRT启动后30 d的死亡率明显高于FO<10%的患者,差异具有统计学意义(χ^(2)=13.970,P<0.001)。结论SAKI患者启动CRRT时,FO是患者30 d内死亡的独立危险因素,FO≥10%时患者的死亡风险增加,提示液体超负荷时应尽早启动CRRT。

Objective To investigate the effect of fluid loading during continuous renal replacement therapy(CRRT)on the prognosis of patients with sepsis complicated with acute kidney injury(SAKI).Methods A total of 118 SAKI patients who underwent CRRT in Hezhou Guangji Hospital from January 2019 to December 2021 were selected.The baseline data and clinical data were compared.Logistic regression model was used to analyze the risk factors affecting the prognosis of SAKI patients.Kaplan-Meier survival curve was used to analyze the survival of SAKI patients after 30 days of CRRT.Results The mortality of 118 patients with AKI at 30 days after CRRT was 37.29%(44/118).The results of factor analysis showed that age,fluid overload(FO),positive fluid balance,time from diagnosis to CRRT,total CRRT time,urine volume,sequential organ failure(SOFA)score and acute physiology and chronic health evaluationⅡ(APAHCHEⅡ)were the main factors for the death of SAKI patients within 30 days after CRRT initiation,among which FO,SOFA score and positive fluid balance were independent risk factors(OR>1,P<0.05).Kaplan-Meier survival curve results showed that the cumulative survival rates of FO≥10%and FO<10%were 44.20%and 77.30%,respectively,and the overall average survival rate was 62.70%.The mortality of patients with FO≥10%was significantly higher than that of patients with FO<10%at 30 days after CRRT start.The difference was statistically significant(χ^(2)=13.970,P<0.001).Conclusions When CRRT is initiated in SAKI patients,FO is an independent risk factor for death within 30 days.When FO≥10%,the risk of death increases,suggesting that CRRT should be initiated as early as possible when fluid overload occurs.