心脏手术相关急性肾损伤并接受CRRT患者的死亡危险因素研究

Risk factors of death in patients with cardiac surgery-related acute kidney injury receiving CRRT

目的分析心脏手术相关急性肾损伤(CS-AKI)并接受连续性肾脏替代治疗(CRRT)患者的死亡危险因素。方法选取陆军军医大学第一附属医院2018年1月至2022年3月发生CS-AKI并接受CRRT的成年患者45例作为研究对象。根据患者出院时的治疗结果,将患者分为存活组和死亡组,进行回顾性分析。采用单因素分析和多因素logistic回归分析死亡相关的危险因素。结果纳入研究的45例患者中,存活26例,死亡19例,死亡率为42.22%。死亡组术前乳酸值高于存活组,差异有统计学意义(P=0.031)。单因素分析结果显示,行心脏手术后接受CRRT患者死亡的危险因素包括:肺部感染(P=0.015)、CRRT 72 h后乳酸值(P=0.004)、高血压(P=0.030)。多因素logistic回归分析结果显示,CRRT 72 h后乳酸值(P=0.026)是患者死亡的独立危险因子。结论将CRRT 72 h后乳酸值作为独立危险因子进行早期识别,及时调整治疗方案,有助于改善CS-AKI患者的预后。

Objective To analyze the risk factors of death in the patients with cardiac surgery-related acute kidney injury(CS-AKI)receiving continuous renal replacement therapy(CRRT).Methods A total of 45 adult patients developing CS-AKI and receiving CRRT in this hospital from January 2018 to March 2022 were selected as the research subjects,divided into the survival group and death group according to the treatment results of the patients at discharge,and the retrospective analysis was carried out.The risk factors related to death were analyzed by the univariate analysis and multivariate logistic regression.Results Among the included 45 patients in the study,26 cases survived and 19 cases died,with a fatality rate of 42.22%.The preoperative lactic acid value in the death group was higher than that in the survival group,and the difference was statistically significant(P=0.031).The univariate analysis results showed that the risk factors for death in the patients receiving CRRT after cardiac surgery included the pulmonary infection(P=0.015),lactate value after 72 h of CRRT(P=0.004)and hypertension(P=0.030).The multivariate Logistic regression analysis results showed that the lactate value after 72 h of CRRT(P=0.026)was an independent risk factor for the death of the patients.Conclusion Early identification of the lactate value after 72 h of CRRT as an independent risk factor and timely adjustment of the treatment plan will help to improve the prognosis of the patients with CS-AKI.