治疗危重型肾综合征出血热的时机及预后影响因素  

The timing of treatment and prognostic factors by continuous renal replacement therapy in severe hemorrhagic fever with renal syndrome

作　　者：马晓华 李飞宇 杨海敏 王凤兰 赵海[2] MA Xiaohua;LI Feiyu;YANG Haimin;WANG Fenglan;ZHAO Hai(Department of lntensive Care Unit in No.8 Hospital of Xi ＇an City,Xi ＇an,Shaanxi 710061,China)

机构地区：[1]西安市第八医院重症医学科,陕西西安710061 [2]陕西省人民医院检验科,陕西西安710068

出　　处：《中国热带医学》2018年第9期927-930,共4页China Tropical Medicine

摘　　要：目的分析连续性肾脏替代治疗(CRRT)在危重型肾综合征出血热不同时期的疗效及预后影响因素。方法选取2013年10月—2017年2月行CRRT治疗的135例危重型肾综合征出血热患者作为研究对象,根据行CRRT治疗时间的不同分为低血压休克期组(70例)及少尿期组(65例)。分别研究两组患者临床治愈情况、并发症情况、CRRT治疗时间、重症监护(intensive care unit,ICU)住院时间、住院费用及预后情况,最后采用Logistic回归分析影响经CRRT治疗危重型肾综合征出血热预后的因素。结果低血压休克期组治愈率(92.86%,65/70)明显高于少尿期组(78.46%,51/65),差异有统计学意义(P<0.05);低血压休克期组并发症发生率和死亡率明显低于少尿期组(P<0.05);低血压休克期组CRRT时间、重症ICU住院时间及住院费用均低于少尿期组(P<0.05);经单因素分析得知,年龄、身高体重(bodymass index,BMI)指数、并发症累计数、CRRT时间及重症ICU住院时间不同,经CRRT治疗的危重型肾综合征出血热预后也不同(P<0.05);经Logistic回归分析得知,BMI指数≥25及并发症累计数≥4项是影响经CRRT治疗的危重型肾综合征出血热的预后影响因素(P<0.05)。结论肥胖及多重并发症是经CRRT治疗的危重型肾综合征出血热的危险因素,但早期开始连续性肾脏替代治疗可有效改善危重型肾综合征出血热患者的疗效及预后,值得临床推广。Objective To study the prognostic factors and efficacy of continuous renal replacement therapy（CRRT） inpatients with severe hemorrhagic fever with renal syndrome at different stages. Methods Totally 135 patients with severerenal syndrome hemorrhagic fever who were underwent continuous renal replacement therapy from October 2013 to February2017 were collected into this study. 135 patients were divided into early group（70 cases） and middle-late group（65 cases）according to the time of CRRT, respectively. To compare the situation of clinical cure, the complications,the time of continuousrenal replacement therapy and hospitalization time of severe ICU, hospitalization cost, the situation of sequential and theprognosis of two groups. To study the influencing factors of prognosis with CRRT in severe renal syndrome by Logisticregression. Results The cure rate of the early group（92.86%, 65/70） was significantly higher than that of the middle-lategroup（78.46%, 51/65）（P〈0.05）; the incidence of complications and mortality in the early group were significantly lower thanthose in the middle-late group（P〈0.05）; the CRRT time, the hospitalization time and hospitalization costs of the severe ICUgroup were lower than those of the middle and late group,respectively（P〈0.05）; The ANOVA analysis showed that age, weight,complications, CRRT time and hospitalization time of severe ICU and the prognosis of severe hemorrhagic fever with renalsyndrome was also different between two groups（P〈0.05）; the logistic regression analysis showed that the BMI≥ 25 and theincidence of complications≥ 4 were the risk factors of severe hemorrhagic fever with renal syndrome by CRRT treatment（P〈0.05）. Conclusion Weight and many kinds of complication are the risk factors with CRRT of severe hemorrhagic fever withrenal syndrome, but early continuous renal replacement therapy can effectively improve the curative effect and prognosis ofsevere hemorrhagic fever with renal syndrome, which is worthy of clinical

关 键 词：危重型肾综合征出血热 连续性肾脏替代治疗 疗效 预后影响因素 

分 类 号：R512.8[医药卫生—内科学]