接受连续性肾脏替代治疗的危重症急性肾损伤患者出院时肾脏恢复的相关因素影响分析  

Analysis of relevant factors for influencing renal recovery at discharge in critically ill patients with acute kidney injury requiring continuous renal replacement therapy

作　　者：肖爱兵 张琴[1] 王昌明[1] 张楚明[1] 郑诚[1] Xiao Aibing;Zhang Qin;Wang Changming;Zhang Chuming;Zheng Cheng(Zhejiang Taizhou Municipal Hospital ICU,Zhejiang Taizhou 318000,China)

机构地区：[1]浙江省台州市立医院重症医学科,318000

出　　处：《中国医师进修杂志》2019年第10期936-941,共6页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨影响接受连续性肾脏替代治疗(CRRT)的危重症急性肾损伤(AKI)患者出院时肾脏恢复情况的潜在危险因素.方法采用单中心、回顾性研究,纳入2014年6月至2017年12月入住浙江省台州市立医院重症医学科(ICU)接受CRRT的危重症AKI患者,根据出院时肾脏恢复情况分为肾脏恢复组及肾脏未恢复组.记录两组患者入ICU时的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及序贯器官功能衰竭(SOFA)评分,AKI诊断时的初始血肌酐(初始SCr)水平、乳酸水平及初始估算肾小球滤过率(初始eGFR),肾脏替代治疗(RRT)总时长及CRRT开始前无尿时长,比较两组患者的住ICU时长及住院时长,采用多因素Logistic回归分析影响危重症AKI患者出院时肾脏恢复的潜在危险因素.结果共纳入接受CRRT的危重症AKI患者115例,其中肾脏恢复组45例,肾脏未恢复组70例,出院时肾脏恢复率达39.1%(45/115);住院期间死亡59例,住院病死率达51.3%(59/115).与肾脏未恢复组比较,肾脏恢复组患者的APACHEⅡ评分[(21.73±2.66)分比(23.19±4.41)分,P=0.03]、SOFA评分[(11.02±2.22 )分比(12.79±2.82)分,P=0.001]、乳酸水平[(3.82±1.34)mmol/L比(4.47±1.52)mmol/L,P=0.021]、初始 SCr[(2.151±0.677)mg/dl 比(2.505±0.792)mg/dl,P=0.015]、CRRT 开始前无尿时长[(11.80±4.71)h比(19.11±5.98)h,P=0.005]及RRT总时长[(8.64±3.42)d比(15.81±5.07)d,P=0.001]均明显更低,而初始eGFR更高[(36.26±14.74)ml/(min·1.73 m^2)比(30.07±10.38) ml/(min·1.73 m^2),P=0.009];肾脏恢复组的住ICU时长[(12.58±4.78)d比(15.30±5.45)d,P=0.007]及住院时长[(19.58±6.44)d比(22.11±5.90)d,P=0.032]均显著低于肾脏未恢复组.多因素Logistic回归分析显示SOFA评分(OR=0.700,95% CI0.521~0.941;P=0.018)、CRRT开始前无尿时长(OR=0.782,95% CI0.689~ 0.888;P<0.01)及 RRT 总时长(OR=0.673,95% CI0.565~0.801;P<0.01)是影响危重症AKI患者出院时肾脏恢复的独立危险因素,而初始eGFR (OR=1.061,95% CI1.003~1.121;P=0.Objective To investigate the potential risk factors for influencing renal recovery at discharge in critically ill patients with acute kidney injury (AKI) requiringcontinuous renal replacement therapy (CRRT). Methods This was a single-center, retrospective study. Critically ill patients with AKI requiring CRRT adimitted to the Department of Intensive Care Unit (ICU) in Taizhou Municipal Hospital, Zhejiang province, from June 2014 to December 2017 were included and divided into two groups according to the status of renal recovery at discharge as renal recovery group and renal non-recovery group. The data of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score and sequential organ failure assessment (SOFA) score at adimission to ICU, initial serum creatinine (initial SCr) and lactate level and initial estimated glomerular filtration rate (initial eGFR) at time of AKI diagnosis, and total time of RRT and duration of anuria before CRRT were analyzed. Length of ICU stay and length of hospital stay in both groups were also analyzed. Multivariate logistic regression was taken to analyze the potential risk factors for influencing renal recovery at discharge in critically ill patients with AKI. Results A total of 115 critically ill patients with AKI requiring CRRT were included, of which whom 45 cases were in renal recovery group and 70 cases were in renal non-recovery group, and the renal recovery rate at discharge was 39.1%(45/115);59 patients were dead during hospitalization and the hospital mortality was 51.3%(59/115). Compared with renal non-recovery group, renal recovery group have a lower value of APACHEⅡ score [(21.73±2.66) scores vs.(23.19±4.41) scores, P=0.03), SOFA score [(11.02±2.22) scores vs.(12.79±2.82) scores, P=0.001], lactate level [(3.82±1.34) mmol/L vs.(4.47±1.52) mmol/L, P=0.021],initial SCr [(2.151±0.677) mg/dl vs.(2.505±0.792) mg/dl, P=0.015], duration of anuria before CRRT[(11.80±4.71) h vs.(19.11±5.98) h, P=0.005] and total time of RRT [(8.64±3.42) d vs.(15.81±5.07) d,

关 键 词：急性肾功能不全 肾替代疗法 危重症 危险因素 

分 类 号：R692[医药卫生—泌尿科学]