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作 者:丁文军[1] 刘华[1] 季强[2] 王玺胜[2] 蔡建志[2] 梅运清[2]
机构地区:[1]复旦大学附属中山医院心外科,上海200032 [2]同济大学附属同济医院心胸外科
出 处:《中华医学杂志》2013年第22期1737-1739,共3页National Medical Journal of China
摘 要:目的评估连续性静脉-静脉血液透析(CVVHD)治疗心脏术后急性肾损伤(AKI)失败的危险因素。方法2005年1月-2012年12月在同济医院心胸外科因心脏手术后AKI行CVVHD治疗的成年患者分为CVVHD治疗失败组和治疗成功组。回顾性分析患者术前、术中、术后相关临床资料。结果93例患者被纳入该研究,其中63例治疗成功,30例治疗失败,CVVHD治疗失败率为32.2%,病死率19.4%。通过单因素分析和多因素Logistic回归分析,CVVHD治疗心脏术后AKI失败的独立危险因素有:术前LVEF(OR:0.61,95%CI0.42~0.85)和从少尿到透析的间隔时间(OR=2.76,95%CI1.51—5.83)。结论术前左室受损是CVVHD治疗心脏术后AKI失败的危险因素。CVVHD实施越早,患者预后越好。Objective To evaluate the independent risk factors for failure of continuous veno- venous bemodialysis (CVVHD) in the treatment of acute kidney injury (AKI) following cardiac surgery. Methods Adult patients without any prior pre-operative history of chronic renal disease suffering AKI following cardiac surgery and undergoing CVVHD at our center from January 2005 to December 2012 were recruited and divided into either a success group or a failure group. All pre-, intra- and post-operative data were collected and retrospectively analyzed. Results Ninety-three adult patients were enrolled. Among them, sixty-three patients survived with a failure rate of 32.2% and a mortality rate of 19.4%. Through univariate analysis and multivariate Logistic regression, independent risk factors for failure of CVVHD in the treatment of post-operative AKI included pre-operative LVEF ( OR = 0. 61, 95% C10. 42 - 0.85 ) and duration of oliguria until dialysis ( OR = 2.76, 95% C1 1.51 - 5, 83 ). Conclusion Pre-operative impaired left ventricular function is an important risk factor for failure of CVVHD in the treatment of AKI after cardiac surgery. The sooner the implementation of CVVHD, the better prognosis.
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