心脏术后行连续性肾脏替代治疗患者的死亡危险因素分析

Risk Factors of Death in Patients Undergoing Continuous Renal Replacement Therapy after Cardiac Surgery

目的回顾性分析心脏手术后行连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)治疗患者的死亡危险因素。方法回顾性分析2007年7月至2014年6月在上海市胸科医院行CRRT治疗的心脏术后成年患者66例的临床资料,男38例、女28例,平均年龄(59.11±12.62)岁。根据出院时治疗结果分为存活组和死亡组。采用单因素分析和logistic多因素分析死亡相关的危险因素。结果 66例心脏术后急性肾损伤患者被纳入该研究,其中18例存活,48例死亡。CRRT治疗患者死亡率为72.7%。Logistic回归分析显示,心脏术后行CRRT治疗患者死亡的危险因素有:术后第1 d低血压(B=2.897,OR=18.127,P=0.001),少尿到血滤间隔时间(B=0.168,OR=1.183,P=0.024),术后第1 d血小板值(B=-0.026,OR=0.974,P=0.001)。结论术后第1 d低血压是心脏术后CRRT患者死亡的主要危险因素,需及早防治。尽早行CRRT能改善预后。术后第1 d血小板值是保护因素,血小板值越低,预后越差。

Objective To investigate the risk factors of death in patients undergoing continuous renal replacement therapy(CRRT) after cardiac surgery.Methods We retrospectively analyzed records of 66 adult patients without history of chronic renal failure suffering acute kidney injury(AKI) following cardiac surgery and undergoing CRRT in our hospital between July 2007 and June 2014.There were 38 males and 28 females with mean age of 59.11±12.62 years.They were divided into a survival group and a non-survival group according to prognosis at discharge.All perioperative data were collected and analyzed by univariate analysis and multivariate logistic regression analysis.Results In sixty-six adult patients,eighteen patients survived with a mortality rate of 72.7%.Through univariate analysis and multivariate logistic regression,risk factors of death in the post-operative AKI patients requiring CRRT included hypotension on postoperative day 1(B=2.897,QR=18.127,P=0.001),duration of oliguria until hemofiltration(B=0.168,OR=1.183,P=0.024),and blood platelet on postoperative day 1(B=- 0.026,QR=0.974,P=0.001).Conclusion Hypotension on postoperative day 1(POD1)is the predominant risk factor of death in patients requiring CRRT after cardiac surgery,while blood platelet on POD1 is a protective factor.If CRRT is required,the sooner the better.