重症超声评价老年心力衰竭合并急性肾损伤患者行血液滤过治疗预后影响因素  

Evaluation of prognostic factors of elderly patients with acute renal injury treated with hemofiltration by critical care ultrasound

作　　者：崔晓琼[1] 邹永明[2] 高文卿[1] 刘欢[1] 张玉璐 王为[1] 于广栋 潘坤颖 Cui Xiaoqiong;Zou Yongming;Gao Wenqing;Liu Huan;Zhang Yulu;Wang Wei;Yu Guangdong;Pan Kunying(Department of Cardiology Coronary Care Unit,The Third Central Hospital of Tian Jin,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases,Clinical and Training Center of Tianjin Extracorporeal Membrane Oxygenation,Tianjin 300170,China;Department of Neurology,Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市第三中心医院心脏中心CCU、天津市重症疾病体外生命支持重点实验室、天津市ECMO治疗与培训基地,天津300170 [2]天津市环湖医院神经内科,天津300350

出　　处：《中华老年医学杂志》2024年第7期869-875,共7页Chinese Journal of Geriatrics

基　　金：天津市医学重点学科(专业)建设项目(TJYXZDXK-035A);天津市"131"创新人才团队项目(201939)。

摘　　要：目的应用重症超声(CCUS)评价老年心力衰竭(HF)合并急性肾损伤(AKI)患者行间歇性静脉-静脉血液滤过(IVVH)治疗后肾功能恢复的影响因素及其预测价值。方法回顾性分析天津市第三中心医院心脏中心(CCU)2019年1月至2022年7月行IVVH治疗的HF(NYHFⅢ~Ⅳ级)合并AKI(2~3期)体液负荷过重且对利尿剂抵抗的老年患者临床资料,记录患者一般资料和IVVH前、IVVH后7 d临床生化及重症超声监测指标的变化,按照患者肾功能恢复情况分为肾功能恢复组和肾功能未恢复组,分别比较两组患者在IVVH治疗后30 d和90 d时肾功能恢复情况,应用Logistic回归及受试者工作特征(ROC)曲线和曲线下面积(AUC)分析各影响因素对患者肾功能恢复的预测价值。结果本研究共纳入178例患者,IVVH开始治疗后30 d肾功能恢复143例、未恢复35例,90 d时肾功能恢复138例、未恢复40例。30 d和90 d恢复组中NYHFⅢ级的患者比例、糖尿病患者比例、β_(2)-微球蛋白(β_(2)-MC)下降幅度、胱抑素C(CysC)下降幅度、主动脉血流速度时间积分(VTI)升高幅度、心排血量(CO)升高幅度、肾叶间动脉阻力指数(RI)下降幅度高于未恢复组(均P<0.05);30 d和90 d恢复组中IVVH总治疗时间少于未恢复组(P<0.05)。Logistic回归分析结果显示IVVH总治疗时间(OR=1.067,P<0.001)、VTI(OR=0.652,P=0.024)、CO(OR=0.037,P<0.001)、肾叶间动脉RI(OR<0.001,P=0.010)在IVVH治疗7 d内变化幅度是AKI患者30 d和90 d肾功能恢复的独立影响因素;ROC曲线显示30 d肾功能恢复独立影响因素的预测价值:VTI的曲线下面积(AUC)为0.610(95%CI:0.513~0.707),CO的AUC为0.760(95%CI:0.656~0.864),肾叶间动脉RI的AUC为0.694(95%CI:0.589~0.799);ROC曲线显示90 d肾功能恢复独立影响因素的预测价值:VTI的AUC为0.654(95%CI:0.564~0.744),CO的AUC为0.697(95%CI:0.605~0.789),肾叶间动脉RI的AUC为0.605(95%CI:0.495~0.715)。结论CCUS监测的VTI、CO、肾叶间动脉RI不仅是评价老年HF合并AKObjective To evaluate the influencing factors and predictive value of renal function recovery in elderly patients with heart failure(HF)and acute renal injury(AKI)after intermittent veno-venous hemofiltration(IVVH)using critical care ultrasound.Methods The clinical data of elderly patients with heart failure(NYHF grade Ⅲ~Ⅳ)complicated with acute kidney injury(stage 2~stage 3)who underwent intravenous veno-venous hemofiltration(IVVH)in the critical care unit(CCU)of our hospital were retrospectively analyzed.The demographic information of the patients and the changes in clinical biochemical and critical care ultrasound monitoring parameters before and after 7 days of IVVH were recorded.Based on the recovery of renal function,the patients were divided into two groups:a renal function recovery group and a renal function non-recovery group.Logistic regression and Receiver Operating Characteristic Curve(ROC)curve analysis were performed to determine the predictive value of various influencing factors on the recovery of renal function in patients.Results A total of 178 patients were enrolled in this study.After starting IVVH treatment,renal function recovered in 143 cases at 30 days,and in 138 cases at 90 days.However,renal function did not recover in 35 cases at 30 days,and in 40 cases at 90 days.The proportion of NYHFⅢ patients、the proportion of diabetic patients、the decrease of Beta 2-microglobulin(β2-MC)、the decrease of Cystain C(CysC)、the increase of venous transit time index(VTI)、the increase of Cardiac Output(CO)and the decrease in renal blood flow resistance index(RI)in the recovery groups at both 30 days and 90 days was significantly higher than that in the non-recovery group(all P<0.05).The total treatment time of IVVH in the recovery group was significantly shorter than that in the non-recovery group,with 30 days and 90 days(P<0.05).Logistic analysis revealed that the total treatment time of IVVH(OR=1.067,P<0.001),VTI(OR=0.652,P=0.024),CO(OR=0.037,P<0.001),and RI(OR<0.001,P=0.010)of the inter

关 键 词：超声检查 肾功能不全 急性 重症超声 间歇性静脉-静脉血液滤过 

分 类 号：R445.1[医药卫生—影像医学与核医学] R541.6[医药卫生—诊断学] R692[医药卫生—临床医学]