连续性血液滤过治疗严重心肾综合征患者死亡的危险因素  

Mortality risk factors in severe cardiorenal syndrome patients treated with continuous hemofiltration therapy

作　　者：陆非平[1] 陈炜[1] 赵磊[1] 甄洁[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院重症医学科,100038

出　　处：《实用医学杂志》2016年第20期3315-3318,共4页The Journal of Practical Medicine

基　　金：北京市自然科学附属北京基金资助项目(编号:7153169)

摘　　要：目的:探讨连续性血液滤过治疗严重心肾综合征患者的死亡危险因素,以优化选择获益更多患者。方法:采用回顾性研究方法,选取2012年5月至2015年5月首都医科大学附属北京世纪坛医院重症医学科收治的68例严重心肾综合征患者的临床资料,按住院期间死亡或生存分为两组,分析临床特征,采用Logistic回归分析明确严重心肾综合征死亡的独立危险因素。结果 :死亡组36例、存活组32例。死亡组患者年龄、机械通气比率、血管活性药物应用比率、APACHEⅡ评分、白细胞计数、中性粒细胞计数、C-反应蛋白、左室舒张末内径、左室收缩末内径均高于存活组;而血红蛋白、血肌酐、左室射血分数、血滤平均单次脱水量均低于存活组,差异均具有统计学意义。Logistic回归分析示:年龄、血管活性药物应用、APACHEⅡ评分、白细胞计数为严重心肾综合征死亡的独立危险因素。结论:严重心肾综合征患者的心功能状态、机械通气治疗、血滤治疗平均单次脱水量、血红蛋白及C反应蛋白水平与预后密切相关。患者年龄、连续性血液滤过治疗时的感染状况、血管活性药物应用、APACHEⅡ评分是严重心肾综合征住院期间死亡的重要危险因素。Objective To investigate mortality risk factors in patients with severe cardiorenal syndrome treated with continuous hemofiltration therapy. So we can optimally select patients who may benefit more from this therapy. Methods The clinical data of 68 severe cardiorenal syndrome patients admitted to the ICU of Beijing Shijitan Hospital from May 2012 to May 2015 were retrospectievly analyzed and evaluated. These patients were divided into two groups based on survival or death during hospitalization. Logistic regression analysis was employed to identify independent risk factors for death of patients with severe cardiorenal syndrome during ICU stay. Results There were 36 cases in the death group and 32 cases in the survival group. In the death group,the age,mechanical ventilation rates, vasoactive drug application rates, leukocytes, neutrophils, C-reactive protein,left ventricular end-diastolic diameter and left ventricular end-systolic diameter were significantly higher than those in the survival group,while hemoglobin, serum creatinine, left ventricular ejection fraction, average single amount of dehydration in continuous hemofiltration process were significantly lower than those in the survival group. Logistic regression analysis showed that age, vasoactive drug application rates, APACHE Ⅱscore and leukocytes were independent risk factors of mortality. Conclusions Cardiac function, mechanical ventilation therapy, average single amount of dehydration in continuous hemofiltration, hemoglobin, C-reactive protein were closely related to the prognosis of severe cardiorenal syndrome patients. The patient′s age,infection,vasoactive drug application, APACHEⅡ score were important risk factors of mortality during hospitalization.

关 键 词：严重心肾综合征 病死率 危险因素 

分 类 号：R541.6[医药卫生—心血管疾病] R692.5[医药卫生—内科学]