心力衰竭患者实施连续性肾替代治疗的临床特征及预后分析  

Clinical features and prognosis of the patients with heart failure undergoing continuous renal replacement therapy

作　　者：赵智睿 程虹[1] 陈岚[1] 陈文梅[1] 卞维静[1] ZHAO Zhi-rui;CHENG Hong;CHEN Lan;CHEN Wen-mei;BIAN Wei-jing(Division of Nephrology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院肾内科,北京100029

出　　处：《中国血液净化》2021年第4期229-233,共5页Chinese Journal of Blood Purification

基　　金：首都卫生发展科研专项项目(2018-2-1051)。

摘　　要：目的了解接受连续性肾替代治疗(continuous renal replacement therapy,CRRT)的心力衰竭(heart failure,HF)患者的临床特征、预后及相关影响因素。方法收集2008年1月~2019年12月北京安贞医院因HF接受CRRT的患者,描述患者的临床特征及分析院内死亡的危险因素。结果共有资料完整的患者85例,总体住院死亡率是35.3%(30/85)、脱离CRRT比例是45.9%(39/85)、依赖透析的比例是18.8%(16/85)。将住院死亡与出院存活组患者组间比较P<0.05的因素进行Logistic回归分析,总体死亡的独立危险因素是射血分数值<40%(OR=4.610,95%CI:1.323~16.058,P=0.016)、慢性心力衰竭(chronic heart failure,CHF)病史(OR=8.448,95%CI 2.071~34.464,P=0.003)及CRRT的启动时间(OR=4.114,95%CI 1.224~13.830,P=0.022)。射血分数减低的HF(heart failure with reduced ejection fractio,HFrEF)组与射血分数保留的HF(heart failure with preserved ejection fractio,HFpEF)组的住院死亡率分别为44.9%(22/49)和22.2%(8/36),具有统计学意义(F=4.673,P=0.031)。结论CRRT的早期启动可能降低住院死亡率。如存在CHF病史,CRRT中频发低血压事件及应用血管活性药是HF患者死亡的危险因素。接受CRRT的HFrEF患者死亡率明显高于HFpEF患者。Objective To study the clinical characteristics,prognosis and risk factors of patients with heart failure(HF)receiving continuous renal replacement therapy(CRRT).Methods The clinical data of HF patients treated with CRRT in Beijing Anzhen Hospital from January 2008 to December 2019 were recruited.Their clinical characteristics and risk factors for death in hospital were analyzed.Results A total of 85 patients with complete data were enrolled in this study.The overall mortality rate in hospital was 35.3%(30/85),45.9%(39/85)patients could get rid of CRRT,and 18.8%(16/85)patients were dependent on maintenance dialysis.Logistic regression analysis was performed based on the comparison of death in hospital and survival patients using the factor of P<0.05.The independent risk factor for overall death was ejection fraction(EF)value<40%(OR:4.610,95%CI:1.323~16.058,P=0.016),chronic HF history(OR:8.448,95%CI:2.071~34.464,P=0.003),and CRRT start time(OR:4.114,95%CI:1.224~13.830,P=0.022).The hospital mortality of HF patients with reduced ejection fraction(HFrEF)and HF patients with preserved ejection fraction(HFpEF)was 44.9%(22/49)and 22.2%(8/36),respectively,which was statistically different(F=4.673,P=0.031).Conclusion Early initiation of CRRT may reduce hospital mortality.History of chronic HF,frequent hypotension events during CRRT and the application of vasoactive drugs were the risk factors for mortality in HF patients.The mortality of HFrEF patients receiving CRRT was significantly higher than that of HFpEF patients.

关 键 词：心力衰竭 射血分数 连续性肾替代治疗 

分 类 号：R459.5[医药卫生—治疗学]