体外膜氧合辅助发生急性肾损伤的危险因素分析

Analysis of risk factors of acute kidney injury during extracorporeal membrane oxygenation assistance

目的 探讨接受体外膜合(ECMO)治疗患者发生急性肾损伤(AKI)的危险因素。方法 回顾性研究2015年11月至2024年1月在湖南省岳阳市中心医院收治的接受ECMO体外生命支持的31名患者,探讨AKI的危险因素。收集患者ECMO术前基本情况、ECMO期间相关临床情况等资料,根据患者是否发生AKI分为非AKI组和AKI组,分别通过单因素分析和logistic回归分析发现可能影响AKI的危险因素。结果 单因素分析结果显示AKI患者16例(51.6%),AKI患者ECMO前高红细胞压积、ECMO初始流量、大面积心肌梗死、液体正平衡累计天数均与AKI相关。多因素分析结果显示,患者红细胞压积(OR 1.24,95%CI:1.027~1.488;P=0.025)、ECMO治疗期间液体正平衡累计天数(OR 2.23,95%CI:1.126~4.418;P=0.021)是ECMO患者发生AKI的危险因素。结论 患者红细胞压积、ECMO治疗期间液体正平衡累计天数是接受ECMO患者发生AKI的危险因素。

Objective To investigate the risk factors of acute kidney injury(AKI) in patients treated with extracorporeal membrane oxygenation(ECMO).Methods Methods A retrospective study was performed on 31 patients who received ECMO in Yueyang Central Hospital of Hunan Province from November 2015 to January 2024 to explore the risk factors of AKI.The basic conditions of patients before ECMO and the relevant clinical conditions during ECMO were collected,and the patients were divided into non-AKI group and AKI group according to whether they developed AKI.Univariate analysis and logistic regression analysis were used to identify potential risk factors that may affect AKI.Results Univariate analysis showed that 16 patients(51.6%) with AKI were associated with pre-ECMO hyperhematocrit,initial ECMO flow,large-scale myocardial infarction,and cumulative days of positive fluid equilibrium.The results of multivariate analysis showed that hematocrit(OR 1.24,95% CI:1.027~1.488;P = 0.025) and cumulative days of positive fluid equilibrium during ECMO treatment(OR 2.23,95% CI:1.126~4.418;P = 0.021) were risk factors for AKI in ECMO patients.Conclusion Hematocrit and cumulative days of positive fluid equilibrium during ECMO treatment and hematocrit are risk factors for AKI in patients undergoing ECMO.