【摘要】 目的探讨心血管手术相关急性肾损伤患者行连续性肾脏替代治疗后不同预后的相关因素。方法本研究纳入2015年1月至2018年12月在南京医科大学第一附属医院住院行心血管手术治疗且接受连续性肾脏替代治疗的患者,按90 d是否死亡和90 d内RRT治疗天数(≤14 d,15～90 d,> 90 d)将患者分为4组,分析90 d死亡、90 d透析依赖、90 d延迟摆脱透析的相关影响因素。结果本研究共纳入210例患者,平均随访400 d。其中90 d死亡114例,90 d生存且14 d内摆脱透析37例,90 d生存15～90 d内摆脱透析46例,90 d生存且透析依赖13例。多因素Cox回归显示:90 d死亡的独立危险因素包括高龄(HR=1.029,95%CI:1.013～1.045,P <0.001)、术前血清肌酐低(HR=0.993,95%CI:0.987～0.998,P=0.008)、CRRT前APACHEⅡ高评分(HR=1.043,95%CI:1.004～1.084,P=0.028)、CRRT前SOFA评分高(HR=1.130,95%CI:1.052～1.213,P <0.001)、CRRT前脓毒症(HR=2.327,95%CI:1.591～3.403,P <0.001)、CRRT前过低的舒张压(HR=0.979,95%CI:0.963～0.996,P=0.013)。90 d存活患者透析依赖的独立危险因素包括术前较低的e GFR(HR=0.962,95%CI:0.940～0.984,P <0.001)。90 d存活患者中延迟摆脱透析的危险因素有血清白蛋白低(OR=0.837,95%CI:0.717～0.977,P=0.024)、机械通气时间长(OR=1.434,95%CI:1.175～1.749,P <0.001)、CRRT前尿量少(OR=0.739,95%CI:0.623～0.876,P <0.001)。结论心血管手术相关急性肾损伤并行连续性肾脏替代治疗患者中,90 d死亡与高龄、CRRT前疾病的严重程度、脓毒症和过低的舒张压有关; 90 d存活患者透析依赖与患者术前较差的肾功能有关;90 d存活患者延迟摆脱透析与血清白蛋白低、机械通气时间长、CRRT前尿量少有关。更多还原

【Abstract】 Objective To investigate the prognostic factors in patients with cardiac and vascular surgery-related acute kidney injury after continuous renal replacement therapy.Methods This study included patients admitted to the First Affiliated Hospital of Nanjing Medical University between January 2015 to December 2018, who underwent major cardiovascular surgery followed by continuous renal replacement therapy(CRRT).The patients were divided into 4 groups according to whether they survived within 90 days and the duration of RRT [≤14 days(rapid cessation),15-90 days(delayed cessation),and > 90 days(dialysis dependence) ].Risk factors for 90-day mortality,90-day dialysis dependence,and90-day delayed cessation of dialysis were analyzed.Results A total of 210 patients were included in this study,with an average follow-up duration of 400 days.Among them,114 patients died within 90 days,37 patients survived with rapid cessation of RRT,46 patients survived with delayed cessation of RRT,and13 patients survived with dialysis dependence.Multivariate Cox regression analysis showed that the independent risk factors of 90-day mortality included elder age(HR = 1.029,95% CI: 1.013-1.045,P <0.001),low level of preoperative serum creatinine(HR = 0.993,95% CI: 0.987-0.998,P = 0.008),high score by APACHE Ⅱ before CRRT(HR = 1.043,95% CI: 1.004-1.084,P = 0.028),high score by SOFA before CRRT(HR = 1.130,95% CI: 1.052-1.213,P < 0.001),sepsis before CRRT(HR = 2.327,95% CI: 1.591-3.403,P < 0.001),and low level of diastolic blood pressure before CRRT(HR = 0.979,95% CI: 0.963-0.996,P = 0.013).The independent risk factors for patients survived with dialysis dependence consisted of low preoperative e GFR(HR = 0.962,95% CI: 0.940-0.984,P < 0.001).The risk factors for patients survived with delayed cessation of dialysis were low level of serum albumin(OR =0.837,95% CI: 0.717-0.977,P = 0.024),long duration of mechanical ventilation(OR = 1.434,95%CI: 1.175-1.749,P < 0.001),and low level of urine volume before CRRT(OR = 0.739,95% CI: 0.623-0.876,P < 0.001).Conclusion In patients with cardiovascular surgery-associated acute kidney injury requiring CRRT,90-day mortality was associated with elder age,severity of disease,sepsis,and low level of diastolic blood pressure before CRRT.Patients survived at 90-day having dialysis dependence were associated with poor preoperative renal function.Patients survived at 90-day having delayed cessation of dialysis were associated with low level of serum albumin,long duration of mechanical ventilation,and low level of urine volume before CRRT.更多还原