心内科病房急性肾损伤且行肾脏替代治疗患者短期预后不良的危险因素分析  

Analysis of risk factors for short-term poor prognosis in cardiology-wards patients undergoing renal replacement therapy due to acute kidney injury

作　　者：王小龙 吴杰[1] 冯哲[1] 文浩 段姝伟 梁爽[1] 蔡广研[1] Xiaolong Wang;Jie Wu;Zhe Feng;Hao Wen;Shuwei Duan;Shuang Liang;Guangyan Cai(Department of Nephrology,First Medical Center of Chinese PLA General Hospital,State Key Laboratory of Kidney Diseases,National Clinical Research Center for Kidney Diseases,Beijing Key Laboratory of Kidney Diseases,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心肾脏病医学部、肾脏疾病国家重点实验室、国家慢性肾病临床医学研究中心、肾脏疾病研究北京市重点实验室,北京100853

出　　处：《中华肾病研究电子杂志》2024年第5期241-248,共8页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

摘　　要：目的探究心内科病房接受肾脏替代治疗(RRT)的急性肾损伤(AKI)患者的临床特征,并分析其短期预后不良的危险因素。方法回顾性分析2009年1月1日至2018年12月31日期间在解放军总医院第一医学中心心血管内科住院接受RRT治疗的AKI患者。收集AKI患者人口学资料、伴随疾病、AKI病因、RRT启动时生命体征、实验室检查结果、RRT治疗时长、RRT适应症、血管活性药物评分(VIS)、去甲肾上腺素当量(NEE)、急性生理与慢性健康评估Ⅱ(APACHEⅡ)分数、病危和病重天数,以及RRT治疗后28 d患者的生存情况和肾脏预后等指标。对这些AKI患者按照预后情况分为生存组和死亡组后进行分析比较,Logistic回归分析影响患者预后的危险因素。结果共有143例患者入组,其中男性占91例(63.6%),患者年龄中位数为75.0(65.0,81.0)岁,28 d后共有87例死亡,死亡率为60.8%。大多数患者同时存在多种基础疾病,主要的AKI病因是肾脏灌注不足(63.3%),而主要的RRT适应症是容量负荷过重(81.1%)。在进行RRT治疗4周后,共有56例存活,其中14例(25%)可以停止透析,42例(75%)仍需透析。两组AKI患者的总APACHEⅡ评分为(20.65±5.63)分,但两组间无显著差异(P=0.187)。死亡组的VIS、NEE评分高于生存组(P均<0.05)。单因素Logistic回归分析显示,高龄、低身体质量指数(BMI)、低平均动脉压、高血红蛋白、开始RRT时的较低血清肌酐、凝血酶原时间(PT)、血浆活化部分凝血活酶时间延长、脑梗/脑出血、急性心肌梗死、高VIS评分和高NEE是死亡的危险因素。多因素Logistic回归分析显示,低BMI(OR=0.794,95%CI:0.648~0.930,P=0.004)、开始RRT时较低的血清肌酐(OR=0.736,95%CI:0.558~0.971,P=0.030)和PT延长(OR=1.019,95%CI:1.004~1.035,P=0.016)是患者死亡的危险因素。结论在心内科病房急性肾损伤且行肾脏替代治疗的患者中,入院时低BMI、开始RRT时较低的肌酐和凝血酶原时间延长为患者死亡Objective To investigate the clinical characteristics and analyze the risk factors for short-term poor prognosis in cardiology-wards patients undergoing renal replacement therapy(RRT)due to acute kidney injury(AKI).Methods A retrospective analysis was performed on AKI patients treated with RRT in the Cardiology Department of the First Medical Center of the Chinese PLA General Hospital from January 1,2009 to December 31,2018.The AKI patients&apos;data were collected,including demography,concomitant diseases,etiology of AKI,vital signs at RRT initiation,laboratory results,duration of RRT treatment,indications for RRT,vasoactive inotropic score(VIS),norepinephrine equivalent(NEE),acute physiologic assessment and chronic health evaluation II(APACHE II)score,duration of critical and severe illness,and the patients&apos;survival plus renal prognosis at 28 days after RRT treatment.According to the patients&apos;prognosis,they were divided into a survival group and a death group.These AKI patients were divided into a survival group and a death group according to the prognosis,while risk factors affecting the prognosis were analyzed by logistic regression method.Results A total of 143 AKI patients were enrolled,of which 91(63.6%)were males,whose median age was 75.0(65.0,81.0)years,among whom a total of 87 patients died after 28 days,with a mortality rate of 60.8%.Most of the patients had multiple underlying diseases at the time,and the main cause of AKI was renal hypoperfusion(63.3%),but the main RRT indication was volume overload(81.1%).After 4 weeks of RRT treatment,56 patients survived,of whom 14(25%)were able to be off dialysis while 42(75%)still required dialysis.The APACHEⅡscore of the total enrolled AKI patients was(20.65±5.63),but there was no significant difference between the two groups(P=0.187).The death group disclosed higher scores of VIS and NEE than the survival group(P<0.05).Univariate logistic regression analysis showed that advanced age,low body mass index(BMI),low mean arterial pressure,high hemoglob

关 键 词：心内科 肾脏替代治疗 死亡率 

分 类 号：R692[医药卫生—泌尿科学]