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目的评估心脏体外循环术后急性肾损伤行连续性肾脏替代治疗患者发生死亡的危险因素。方法回顾性分析2009年5月至2014年6月我院心脏外科术后行连续性肾脏替代治疗66例患者的临床资料,其中男38例、女28例,平均年龄(59.11±12.62)岁。按照出院时治疗结果分为存活组(18例)和死亡组(48例)。采用logistic多因素回归分析体外循环术后因肾脏功能不全接受连续性肾脏替代治疗患者围手术期死亡危险因素。结果单一因素分析结果提示两组患者术中输血量、术中血糖、血乳酸峰值、术后1 h总胆红素、血小板值、术后1 d内低血压、术后肺部感染、多器官功能障碍(MODS)、少尿到血虑的间隔时间差异均有统计学意义(P<0.05)。多因素logistic回归分析结果提示,两组术后1 d出现低血压、术后血小板值、少尿到血虑的间隔时间差异有统计学意义(P<0.05)。结论加强术中管理,减少出血和输血,控制血糖,积极处理低血压、肺部感染、MODS等并发症,及早启动肾脏替代治疗,有利于降低死亡率,监测术后1 d的血压和血小板对于预后判断具有指导意义。
Objective To evaluate the risk factors for death in patients undergoing continuous renal replacement therapy after acute cardiopulmonary bypass. Methods The clinical data of 66 patients who underwent continuous renal replacement therapy from May 2009 to June 2014 in our hospital were retrospectively analyzed. There were 38 males and 28 females, with an average age of 59.11 ± 12.62 years. According to the treatment results at discharge, the patients were divided into survival group (18 cases) and death group (48 cases). Logistic regression analysis was used to analyze the risk factors of perioperative mortality in patients undergoing continuous renal replacement therapy due to renal insufficiency after cardiopulmonary bypass. Results The results of single factor analysis showed that blood transfusion, intraoperative blood glucose, blood lactate peak, total bilirubin 1 h after operation, platelet value, hypotension within 1 d after operation, postoperative pulmonary infection, multiple organs Dysfunction (MODS), oliguria to bloodseting interval time difference was statistically significant (P <0.05). Multivariate logistic regression analysis showed that there was significant difference (P <0.05) between the two groups in postoperative 1d hypotension, postoperative platelet value, oliguria to bloodsexual interval time. CONCLUSIONS: Intraoperative management, blood loss and blood transfusion, blood glucose control, active treatment of complications such as hypotension, lung infection and MODS, and early initiation of renal replacement therapy are helpful to reduce mortality and blood pressure and platelet on the first postoperative day Prognostic judgment is instructive.