重症急性胰腺炎患者连续肾脏替代疗法序贯治疗后累积液体平衡与预后的关系

Relationship between cumulative fluid balance and the prognosis in the patients with severe acute pancreatitis after continuous renal replacement therapy

目的 探究重症急性胰腺炎(SAP)患者连续肾脏替代疗法(CRRT)序贯治疗后累积液体平衡与预后的关系。方法 选择2018年1月至2023年5月苏州高新区人民医院接受CRRT序贯治疗的102例SAP患者作为研究对象,根据治疗后28 d内的临床结局将患者分为预后良好组(79例)和预后不良组(23例)。比较两组患者一般资料,治疗1、2、3 d及总体液体量;Kaplan-Meier法比较累积液体负平衡与液体正平衡患者的预后情况;多因素Cox比例风险回归分析影响患者预后的因素;调整混杂协变量后,分析累积液体平衡和其他影响因素与患者预后间的关系;分析累积液体平衡与其他影响因素间的相乘交互作用;建立回归模型并验证其预测效能。结果 总体累积液体负平衡患者预后良好率明显高于液体正平衡患者(Log-rank χ^(2)=46.530,P<0.001);急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分增加、血小板分布宽度(PDW)增加、中性粒细胞与淋巴细胞比值(NLR)增加及C反应蛋白(CRP)升高是影响SAP患者预后的危险因素;累积液体出量增加及液体负平衡是保护因素(P<0.05);调整混杂协变量后,上述变量仍与患者预后独立相关(P<0.05);累积液体平衡联合PDW(OR=3.642,95%CI3.067~4.239,P<0.001)对患者预后的预测效应最高;多因素Cox比例风险回归模型的区分度和准确性较高。结论 CRRT治疗后累积液体平衡状态与SAP患者预后相关,液体负平衡有利于患者生存。

Objective To explore the relationship between cumulative fluid balance and the prognosis in the patients with severe acute pancreatitis(SAP)after continuous renal replacement therapy(CRRT).Methods A total of 102 patients with SAP who received sequential CRRT therapy in the People′s Hospital of Suzhou High-tech Zone from January 2018 to May 2023 were selected.According to the clinical outcome within 28 days after treatment,the patients were divided into good grognosis group(n=79)and poor prognosis group(n=23).The clinical data,1,2,3 d after the treatment and total fluid volume were compared between the two groups.Kaplan-Meier method was used to compare the prognosis of patients with cumulative negative fluid balance and positive fluid balance.Multivariate Cox proportional hazard regression analysis was used to analyze the factors affecting the prognosis of patients.After adjusting the confounding covariates,the relationship of cumulative fluid balance and other influencing factors with the prognosis of patients was analyzed.The multiplicative interaction between cumulative fluid balance and other influencing factors was analyzed.A regression model was established and its prediction efficiency was verified.Results The rate of good prognosis in the patients with cumulative negative fluid balance was significantly higher than that of the patients with positive fluid balance(Log-rankχ^(2)=46.530,P<0.001).The increase of acute physiology and chronic health evaluationⅡ(APACHEⅡ),platelet distribution width(PDW),neutrophil-to-lymphocyte ratio(NLR)and C-reactive protein(CRP)were the risk factors affecting the prognosis of SAP patients,and increased cumulative liquid output and negative liquid balance were protective factors(P<0.05).After adjusting the confounding covariates,the above variables were still independently correlated with the prognosis of the patients(P<0.05).Cumulative fluid balance combined with PDW(OR=3.642,95%CI 3.067-4.239,P<0.001)had the best predictive effect on the prognosis of patients.Multivariate Cox proportional hazard regression model has the higher degree of differentiation and accuracy.Conclusions The state of cumulative fluid balance after CRRT treatment is related to the prognosis of SAP patients,and negative fluid balance is beneficial to the survival of patients.