心脏术后急性肾损伤患者行连续性肾脏替代治疗的死亡危险因素分析  

The analysis of risk factors for death in patients with acute kidney injury undergoing continuous renal replacement therapy after cardiac surgery

作　　者：李明辉[1] 徐雯雯 冯敏[1] 窦艳娜[3] Li Minghui;Xu Wenwen;Feng Min;Dou Yanna(Department of Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Nephrology,The First Peoples Hospital of Shangqiu,Shangqiu 476000,China;Department of Nephrology The First Affiliated Hospital of Zhengzhou University,450052,China)

机构地区：[1]郑州大学第一附属医院重症医学科,郑州450052 [2]商丘市第一人民医院肾内科,商丘476000 [3]郑州大学第一附属医院肾脏内科医学部,郑州450052

出　　处：《中华胸心血管外科杂志》2025年第2期82-90,共9页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(U1404804)。

摘　　要：目的:分析心脏手术相关的急性肾损伤(cardiac surgery-associated acute kidney injury,CSA-AKI)行连续性肾脏替代治疗(CRRT)的患者,死亡组和生存组在术前、术中、术后、CRRT开始时、CRRT结束时两组的指标差异,研究影响患者死亡的危险因素。方法:2020年1月至2022年10月在郑州大学第一附属医院心脏外科住院,因行心脏外科手术,术后合并急性肾损伤并行CRRT的患者共101例(死亡组59例,生存组42例)。通过回顾性分析其临床资料,探讨影响患者30天死亡风险的危险因素。结果:两组患者术后并发症结果显示,死亡组发生MODS、LCOS的比例较大(P<0.05)。多因素回归分析显示,术中平均动脉压低、CRRT开始时SOFA和APACHEⅡ评分高、CRRT结束时血小板低是患者死亡的独立危险因素(P<0.05)。ROC曲线分析显示CRRT开始时SOFA评分和APACHEⅡ评分对接受CRRT的CSA-AKI患者30天死亡风险具有预测价值。结论:术中MAP低、CRRT开始时的SOFA和APACHEⅡ评分高以及CRRT停止时血小板低是CSA-AKI行CRRT患者术后30天死亡风险的独立危险因素。Objective This study intends to analyze the differences of indexes between the death group and the survival group of CSA-AKI patients undergoing CRRT before,during,and after heart surgery,and at the beginning and the end of CRRT,and to study the risk factors affecting the death of patients,so as to provide guidance for improving the prognosis.Methods From January 2020 to October 2022,a total of 101 patients(59 in the mortality group and 42 in the survival group)were admitted to the Department of Cardiac Surgery at the First Affiliated Hospital of Zhengzhou University for cardiac surgery complicated by acute kidney injury necessitating postoperative continuous renal replacement therapy(CRRT).A retrospective analysis of clinical data was conducted to ascertain the risk factors influencing the 30-day mortality rate.ResultsThe postop-erative complications of the two groups showed that the mortality group had a large proportion of MODS and LCOS(P<O.05).Multivariate regression analysis showed that intraoperative mean arterial depression,high SOFA score at the beginning of CRRT,high APACHE II score at the beginning of CRRT,and low platelet at the end of CRRT were independent risk factors for death(P<0.05).ROC curve analysis shows that SOFA score and APACHE I score at the beginning of CRRT have pre-dictive value for the 30-day death risk of CSA-AKI patients receiving CRRT.Conclusion Low intraoperative MAP,high SO-FA and APACHE I scores at the beginning of CRRT,and low platelets at the end of CRRT were independent risk factors for 30-day mortality risk in patients with CSA-AKI undergoing CRRT.

关 键 词：心脏手术 急性肾损伤 连续性肾脏替代治疗 死亡风险 

分 类 号：R47[医药卫生—护理学]