影响心脏外科术后患者连续肾脏替代治疗预后的危险因素分析  

Prognosis S risk factors of the patients with continuous renal replacement therapy

作　　者：杨勇[1] 李小密[1] 李菲[1] 胡尚基[1] 贾士杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所ICU,北京100029

出　　处：《中国急救医学》2009年第8期692-695,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨心脏外科术后连续肾脏替代治疗（CRRT）急性肾损伤（AKI）患者的预后及影响预后的因素。方法回顾性分析我院2005—01—2008—12心脏外科术后CRRT患者的临床资料。结果220例CRRT患者，病死率54．4％。Logistic回归分析显示，死亡危险因素与体外膜肺氧合（ECMO）治疗、多脏器功能障碍综合征（MODS）、CRRT前直接胆红素、CRRT前尿素氮（Bun）、住ICU时间、术后住院时间有关。根据患者CRRT当天的皿肌酐水平及尿量，AKI分为三级，AKIⅢ级病死率高，存活时间短。结论心脏外科术后需要CRRT的AKI患者病死率高。根据肾脏损伤程度分级，AKIⅢ级患者预后较差。肾损伤早期开始CRRT能降低患者的病死率。Objective To investigate the prognosis＇s risk factors of hospitalized patients with acute kidney injury （AKII needing continuous renal replacement therapy （CRRT） after cardiac surgery. Methods The clinical data of 220 patients with AKI needing CRRT in our hospital from January 2005 to December 2008 were studied retrospectively. Results Among 220 patients, male was 142 cases and female was 78 cases. The mortality rate was 54.4% （ 119 cases）. The Logistic regression analysis revealed that extracorporeal membrane oxygenation（ ECMO） therapy, multiple organ dysfunction syndrome （MODS） , direct bilirubin before CRRT, blood urea nitrogen before CRRT, the length of stay in ICU, the length of stay after operation were the related risk factors of prognosis. The classification/staging system for AKI was applied to all the patients, the stage Ⅲ AKI patients showed the high mortality rate and the shortest survival time. Conclusion The patients with AKI requiring CRRT have a high mortality rate. The stage of AKI was related to the survival rate and the survival time. The patients with CRRT at the early stage have a low mortality rate.

关 键 词：连续肾脏替代治疗 急性肾损伤 心脏外科术后 

分 类 号：R692[医药卫生—泌尿科学]