体外膜肺氧合期间患者发生急性肾功能衰竭的危险因素  

Risk factors analysis of acute renal failure in patients with ECMO

作　　者：廖小卒[1] 程周[1] 王立强[1] 李斌飞[1] LIAO Xiaozu, CHENG Zhou, WANG Liqiang, LI Binfei.(Departments of Anesthesiology, Zhongshan City People＇s Hospital, Zhongshart 528403, Chin)

机构地区：[1]广东省中山市人民医院麻醉科,528403

出　　处：《临床麻醉学杂志》2018年第3期241-245,共5页Journal of Clinical Anesthesiology

摘　　要：目的探寻体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)期间患者发生急性肾功能衰竭(acute renal failure,ARF)的危险因素。方法选择本院2006年1月至2014年12月所有接受ECMO辅助患者170例,男91例,女79例,年龄18~73岁。回顾性分析ECMO辅助患者相关资料,收集患者一般资料,包括性别、年龄;相关疾病史,包括高血压病、糖尿病、心脏病史、ECMO前情况;ECMO辅助期间正性肌力药剂量评分值输血量;机械通气时间、ECMO辅助时间、ICU停留时间;并发症;ECMO前乳酸,ECMO期间C反应蛋白和脑尿钠肽(brain natriuretic peptide,BNP)峰值。将ECMO期间患者按是否发生ARF分为两组,先通过组间单因素分析筛选出影响肾功能的可能危险因素,然后经Logistic回归分析确定ECMO辅助ARF的独立危险因素。结果本研究共纳入研究对象170例,其中发生ARF 91例(53.5%),单因素分析:ECMO前行CPR、ECMO前乳酸水平高、ECMO期间正性肌力药剂量评分值高、大量血制品(红细胞、血浆、血小板)输注、C反应蛋白水平高、BNP水平高、长时间的ECMO辅助是患者发生ARF危险因素。多因素分析表明ECMO前高乳酸水平(OR 2.96,95%CI 1.38~6.34,P=0.005),ECMO期间正性肌力药剂量评分值高(OR 3.17,95%CI1.52~6.61,P=0.002)是ECMO辅助患者发生ARF的独立危险因素。结论 ECMO期间患者ARF发生率高,ECMO期间大剂量正性肌力药的应用,ECMO前高乳酸水平是ARF的危险因素。Objective To explore the risk factors of acute renal failure （ARF） in patients with ECMO. Methods Retrospective analysis the patients with ECMO. There were 91 males and 79 females. The age was 18-73 years old. Data of patients′ preoperative basic situation（gender, age, history of related diseases, including hypertension, diabetes, heart history）, related clinical situations during ECMO period, complications were collected. Patients were divided into two groups according to the ARF occurring. We selected the risk factors which may affect the ARF through the single factor analysis, and then determined the independent risk factors that affected the ECMO ARF by logistic regression analysi. Results This study included 170 cases, 91 cases occurred ARF （53.5%）. Single factor analysis： the patient with CPR before ECMO, high lactic acid levels pre-ECMO, high inotropic equivalents, large amounts of red blood cells, plasma and platelet transfusion, high C-reactive protein levels and high BNP levels during ECMO, long time of ECMO support were associated with patients with ARF. Multiple factors analysis showed that high lactic acid levels pre-ECMO （OR 2.96, 95% CI 1.38-6.34）, P=0.005）, high inotropic equivalents （OR 3.17, 95% CI 1.52-6.61, P=0.002） were independent risk factors of ARF in patients with ECMO. Conclusion The patients with ECMO have a high incidence of acute renal failure, large doses of positive inotropic drug and high lactic acid levels are independent risk factors of acute renal failure in patients with ECMO.

关 键 词：体外膜肺氧合 急性肾功能衰竭 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]