危重新生儿连续性肾脏替代治疗死亡的影响因素  

Analysis of factors influencing mortality in critically ill neonates undergoing continuous renal replacement therapy

作　　者：张榕 庄严 彭小明 张帆[1] 李军帅 肖倬君 谢晶晶 郭琼[1] Zhang Rong;Zhuang Yan;Peng Xiaoming;Zhang Fan;Li Junshuai;Xiao Zhuojun;Xie Jingjing;Guo Qiong(Department of Neonatology,the Affiliated Children's Hospital of Xiangya School of Medicine,Central South University(Hunan Children's Hospital),Changsha 410007,China;the First Affiliated Hospital of Jinan University,Guangzhou 510632,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)新生儿科,长沙410007 [2]暨南大学第一临床医学院,广州510632

出　　处：《中华围产医学杂志》2025年第4期280-287,共8页Chinese Journal of Perinatal Medicine

基　　金：湖南省临床医疗技术创新引导项目(2021SK50504)。

摘　　要：目的探讨影响新生儿连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)死亡的危险因素。方法本研究为回顾性研究,选择2019年1月至2023年12月在中南大学湘雅医学院附属儿童医院接受CRRT且校正日龄≤28 d的34例新生儿。根据CRRT过程中是否发生死亡,分为死亡组(n=16)和存活组(n=18)。采用t检验、Wilcoxon符号秩和检验及χ^(2)检验对2组患儿CRRT前一般情况和生化指标、CRRT治疗模式、参数及相关并发症进行统计学分析。同时对CRRT死亡的危险因素采用logistic逐步回归分析。结果34例患儿中死亡率为48.6%(16/34),CRRT日龄为17 d(2~33 d);11例(32.3%)早产儿,其中胎龄最小为27周,CRRT开始前最低体重1700 g。死亡组患儿CRRT前6~12 h尿量、新生儿危重疾病评分均低于存活组[分别为0.05(0.02~1.00)ml/(kg·h)与0.50(0.20~1.05)ml/(kg·h)、(64.50±7.10)分与(77.67±3.65)分,Z或t值分别为10.97和3.91,P值均<0.05],但血管活性正性肌力药物评分(vasoactive inotropic score,VIS)、昏迷比例,以及血钾、丙氨酸转氨酶、天冬氨酸转氨酶、血氨、血乳酸和活化部分凝血活酶时间(activated partial thromboplastin time,APTT)均高于存活组[分别为(86.88±15.80)分与(55.56±24.31)分、11/16与1/18、(7.02±1.73)mmol/L与(5.88±1.53)mmol/L、274.55(132.50~664.98)U/L与31.10(19.03~110.70)U/L、688.20(449.73~3618.13)U/L与96.65(44.15~439.00)U/L、232.75(70.33~1310.85)μmol/L与77.70(49.78~919.05)μmol/L、(11.17±3.36)U/L与(7.99+2.67)U/L及(99.57±39.74)s与(60.97±31.25)s,t、χ^(2)或Z值分别为-4.39、14.81、-2.03、-2.72、-11.81、-3.89、-3.06及-3.17,P值均<0.05]。通过logistic回归分析,发现CRRT前VIS值和血氨水平高为影响死亡的独立危险因素[OR值(95%CI)分别为1.150(1.035~1.278)和1.004(1.002~1.009),P值均<0.05]。结论新生儿CRRT死亡与治疗前VIS评分及血氨水平相关,同时提示治疗启动时要关注短时间尿量的急剧减少、血管活性药物支持力度,以Objective To investigate the risk factors influencing mortality in neonates undergoing continuous renal replacement therapy(CRRT).Methods This retrospective study included 34 neonates with a corrected age of≤28 days who received CRRT at the Affiliated Children's Hospital of Xiangya School of Medicine,Central South University,from January 2019 to December 2023.The neonates were divided into a mortality group(n=16)and a survival group(n=18)based on whether they died during CRRT.Pre-CRRT blood biochemical indices,general condition,CRRT treatment modes,parameters,and related complications were analyzed using t-tests,Wilcoxon signed-rank tests,and Chi-square tests.Logistic stepwise regression analysis was used to screen for risk factors associated with CRRT mortality.Results The mortality rate among the 34 neonates was 48.6%(16/34),with a median CRRT age of 17 days(range:2-33 days).Eleven neonates(32.3%)were preterm,with the youngest gestational age being 27 weeks and the lowest weight before CRRT initiation being 1700 g.The mortality group had lower urine output 6-12 hours before CRRT initiation and lower critical illness scores compared to the survival group[0.05(0.02-1.00)ml/(kg·h)vs.0.50(0.20-1.05)ml/(kg·h),(64.50±7.10)scores vs.(77.67±3.65)scores,Z or t values were 10.97 and 3.91,respectively].However,the vasoactive inotropic score(VIS),proportion of coma,and levels of blood potassium,alanine aminotransferase,aspartate aminotransferase,blood ammonia,blood lactic acid,and activated partial thromboplastin time(APTT)were higher in the mortality group compared to the survival group[(86.88±15.80)scores vs.(55.56±24.31)scores,11/16 vs.1/18,(7.02±1.73)mmol/L vs.(5.88±1.53)mmol/L,274.55(132.50-664.98)U/L vs.31.10(19.03-110.70)U/L,688.20(449.73-3618.13)U/L vs.96.65(44.15-439.00)U/L,232.75(70.33-1310.85)μmol/L vs.77.70(49.78-919.05)μmol/L,(11.17±3.36)U/L vs.(7.99±2.67)U/L,and(99.57±39.74)s vs.(60.97±31.25)s,with t,χ^(2),or Z values of-4.39,14.81,-2.03,-2.72,-11.81,-3.89,-3.06,and-3.17,respectively](all P<0

关 键 词：新生儿 连续性肾脏替代治疗 死亡 危险因素 

分 类 号：R722.1[医药卫生—儿科]