连续性血液滤过治疗心肾综合征患者预后因素分析  

Prognostic factors in cardiorenal syndrome patients treated with continuous hemofiltration therapy

作　　者：李杏[1] 毛慧娟[1] 俞香宝[1] 曾鸣[1] 张波[1] 杨光[1] 葛益飞[1] 朱亚梅[1] 许贤荣[1] 邢昌赢[1] 

机构地区：[1]南京医科大学第一附属医院肾内科,南京210029

出　　处：《中国血液净化》2013年第12期665-670,共6页Chinese Journal of Blood Purification

基　　金："十二五"国家科技支撑计划;项目编号:(2011BAI10B00)

摘　　要：目的了解连续性血液滤过治疗心肾综合征患者的疗效,评估影响其预后的因素,以帮助优化选择获益更多的患者。方法收集连续性血液滤过治疗的心肾综合征患者59例的临床资料按住院期间生存或死亡分为两组,回顾性分析对住院期间死亡率影响的因素。结果生存组30人,死亡组29人,以下统计量在两组之间差异具有统计学意义,具体表示为统计量/单位(生存组比死亡组均数±标准差,P):血滤前血清肌酐umol/L(411.123±239.847比270.393±150.719,P=0.009)、总胆红素umol/L(10.824±7.859比52.741±111.946,P=0.049)、直接胆红素umol/L(4.631±4.057比27.528±58.753,P=0.041);血常规中白细胞109/L(8.027±4.218比11.925±6.416,P=0.008)、中性粒细胞计数109/L(6.530±3.994比10.015±6.029,P=0.011)、血红蛋白g/L(94.13±20.460比108.90±25.753,P=0.018)、红细胞压积(0.2838±0.0555比0.3247±0.0790,P=0.025);心脏超声指标中左室舒张末内径mm(47.22±14.103比62.29±11.470,P=0.019)、左室收缩末内径mm(31.89±10.386比46.00±13.051,P=0.009)、射血分数%(60.333±8.231比50.886±14.580,P=0.05);血滤开始时的收缩压mmHg(131.47±26.271比114.28±20.800,P=0.007)、平均动脉压mmHg(90.200±18.020比80.552±17.357,P=0.041)以及血滤过程的平均脱水量ml(2184.167±889.364比1664.166±775.994,P=0.020)。校正其他因素后,白细胞升高为死亡的危险因素,OR值1.242,95%CI(1.242,1.480);血清肌酐升高不是CRS预后的关键因素,OR值0.994,95%CI(0.989,1.000)。结论血滤开始时的心功能状况,血滤过程的脱水量与预后密切相关。连续性血液滤过治疗起始时的感染和水负荷状况与住院期间死亡独立相关。关注这些指标有助于选择获益更多的适应人群。Objectives We aimed to investigate the efficacy of continuous hemofiltration in patients with cardiorenal syndrome,to assess the factors affecting their prognosis,and thus to help us optimally select patients who can benefit more from this therapy.Methods Forty-nine patients with cardiorenal syndrome treated with continuous hemofiltration were enrolled in this study.To retrospectively analyze the factors affecting mortality,we collected their clinical data including results from laboratory and instrument examinations,and continuous hemofiltration parameters,and divided them into two groups based on survival or death during hospitalization.Results There were 30 cases in the survival group,and 29 cases in the death group.The resuits with statistical differences between the survival group and the death group are as follows：（a） biochemical parameters before continuous hemofiltration including serum creatinine （411.123 ±239.847 vs.270.393 ±150.719 μmol/L,P=0.009）,serum total bilirubin （10.824±7.859 vs 52.741± 111.946 μ mol/L,P=0.049）,direct bilirubin （4.631±4.057 vs.27.528±58.753 μmol/L,P =0.041）,leukocytes （8.027±4.218 vs.11.925±6.416 × 109/L,P=0.008）,neutrophils （6.530±3.994 vs.10.015±6.029 × 109/L,P=0.011）,hemoglobin （94.13±20.460 vs 108.90±25.753 g/L,P=0.018）,and hematocrit （0.2838±0.0555 vs.0.3247±0.0790,P=0.025）; （b） Echocardiographic indicators including left ventricular end-diastolic diameter （47.22 ± 14.103 vs.62.29 ± 11.470mm,P=0.019）,left ventricular end-systolic diameter （31.89±10.386 vs.46.00±13.051mm,P=0.009）,and ejection fraction （60.333±8.231 vs.50.886± 14.580%,P=0.05）; （c） Physical examinations at the beginning of continuous hemofiltration including systolic blood pressure （131.47 ± 26.271 vs.114.28 ± 20.800 mmHg,P=0.007）,and mean arterial pressure （90.200± 18.020 vs.80.552± 17.357 mmHg,P=0.041）; （d） average amount of dehydration in continuous hemofiltration process （2184.167±889.364 vs.1664.166±775.994m

关 键 词：连续性血液滤过 心肾综合征 住院死亡率 血清肌酐 

分 类 号：R459.5[医药卫生—治疗学]