连续性肾脏替代疗法治疗难治性急性左心衰竭患者的预后危险因素分析  

Prognostic risk factors of patients with refractory acute left heart failure treated by continuous renal replacement therapy

作　　者：谢超[1] 肖观清[1] 叶佩仪[1] 冯雪英 孔耀中[1] Xie Chao;Xiao Guanqing;Ye Peiyi;Feng Xueying;Kong Yaozhong(Renal Department of Foshan First People's Hospital,Foshan 528000,China)

机构地区：[1]佛山市第一人民医院肾内科,佛山528000

出　　处：《中华肾脏病杂志》2020年第2期101-105,共5页Chinese Journal of Nephrology

摘　　要：目的通过分析因难治性急性左心衰竭而行连续性肾脏替代疗法(continuous replacement therapy,CRRT)患者的资料,寻找患者预后的影响因素。方法通过佛山市第一人民医院的病历系统及血液透析系统,筛选2012年1月1日至2019年1月1日因难治性急性左心衰竭而行CRRT治疗的所有患者,将所有的患者按照最终治疗结果分为生存组及死亡组。通过分析患者的年龄、性别、心脏原发病、使用血管活性药情况、治疗起始平均动脉压、治疗前尿量、血红蛋白、血清肌酐、血白蛋白、C反应蛋白、脑钠肽、左心室射血分数及CRRT治疗时长等资料,寻找患者预后的影响因素。结果共130例患者被纳入本研究,其中生存组96例,死亡组34例,病死率为26.15%。生存组男性所占比例高于死亡组(71.88%比50.00%,χ2=5.366,P=0.021),起始平均动脉压、治疗前尿量、血清肌酐显著高于死亡组(t=4.677,P<0.001;Z=3.904,P<0.001;Z=2.866,P=0.004),血红蛋白低于死亡组(Z=-2.587,P=0.011),治疗时长短于死亡组(Z=-3.447,P=0.001)。多因素Logistic回归分析结果显示,女性(OR=2.950,95%CI 1.102~7.898,P=0.031)及较高水平血红蛋白(OR=1.024,95%CI 1.004~1.045,P=0.019)是CRRT治疗难治性急性左心衰竭患者死亡的危险因素,而较高水平治疗前平均动脉压(OR=0.959,95%CI 0.930~0.989,P=0.008)和治疗前尿量(OR=0.998,95%CI 0.997~0.999,P=0.004)是患者预后的保护因素。结论即使采用CRRT治疗难治性急性左心衰竭,其病死率仍较高,女性及血红蛋白水平升高是患者预后的危险因素,而治疗前较高水平尿量和治疗前平均动脉压是患者预后的保护因素。Objective To find out the prognostic influencing factors of patients undergoing continuous renal replacement therapy(CRRT)for refractory acute left heart failure.Methods Through the medical system and hemodialysis system in Foshan First People's Hospital,all patients who received CRRT for refractory acute left ventricular heart failure from January 1,2012 to January 1,2019 were searched.All patients were divided into two groups by the final outcome:survival group and death group.Age,sex,initial mean arterial pressure(MAP),primary heart disease,use of vasoactive drugs,urine output before treatment,hemoglobin,serum creatinine,serum albumin,C-reactive protein(CRP),brain natriuretic peptide(BNP),cardiac ejection fraction(EF)and CRRT treatment time were analyzed to find out the prognostic influencing factors.Results A total of 130 cases were collected,including 96 cases in the survival group and 34 cases in the death group,with a total mortality rate of 26.15%.Compared to that in the death group,there were higher proportion of males(71.88%vs 50.00%,χ2=5.366,P=0.021),significantly higher initial MAP(t=4.677,P<0.001),much more urine output before treatment(Z=3.904,P<0.001),significantly higher serum creatinine(Z=2.866,P=0.004),significantly lower hemoglobin(Z=-2.587,P=0.011),significantly shorter time of CRRT(Z=-3.447,P=0.001)in the survival group.Multivariate logistic regression analysis showed that female(OR=2.950,95%CI 1.102-7.898,P=0.031)and higher levels of hemoglobin(OR=1.024,95%CI 1.004-1.045,P=0.019)were the risk factors of death in patients undergoing CRRT for refractory acute left heart failure,while higher levels of mean arterial pressure before treatment(OR=0.959,95%CI 0.930-0.989,P=0.008)and urine volume before treatment(OR=0.998,95%CI 0.997-0.999,P=0.004)were the protective factors for patients'prognosis.Conclusion The mortality of patients with refractory acute left heart failure undergoing CRRT therapy is still very high.Female and higher level of hemoglobin are the risk factors for death,while more uri

关 键 词：肾替代疗法 心力衰竭 预后 危险因素 

分 类 号：R541[医药卫生—心血管疾病]