中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (01): 16-20.doi: 10.3969/j.issn.1671-4091.2019.01.004

• 临床研究 • 上一篇    下一篇

目标导向的肾替代治疗对1 型心肾综合征预后的影响

赵智睿1,陈岚1,陈文梅1,卞维静1,程虹1   

  1. 1. 首都医科大学附属北京安贞医院肾内科
  • 收稿日期:2018-08-30 修回日期:2018-10-31 出版日期:2019-01-12 发布日期:2018-12-25
  • 通讯作者: 卞维静 bianweijing65@163.com E-mail:bianweijing65@163.com
  • 基金资助:

    首都卫生发展科研专项(首发2018-2-1051)

Effect of goal-directed continuous renal replacement therapy (GD-CRRT) on the prognosis of patient with type 1 cardiorenal syndrome

  • Received:2018-08-30 Revised:2018-10-31 Online:2019-01-12 Published:2018-12-25

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摘要： 【摘要】目的比较目标导向的连续性肾脏替代治疗(goal-directed continuousrenal replacement therapy，GD-CRRT)与常规的连续性肾脏替代治疗(continuousrenal replacement therapy，CRRT)对1 型心肾综合征(cardiorenal syndrome，CRS)患者预后的影响。方法对北京安贞医院肾内科在2015 年1 月～2017 年12 月收治的33 例1 型CRS 患者采取GD-CRRT，再匹配选取2010 年1 月～2017 年12 月北京安贞医院33 例接受常规CRRT 的1 型CRS 患者，比较2 组患者的预后(死亡、脱离或依赖透析)。结果GD-CRRT 组的启动时机在诊断CRS 后为15.0(10.0,22.5)h；低血压的发生率为27.3%(9/33)；血管活性药的应用为21.2%(7/33)；住院死亡率为18.2%(6/33)、脱离透析率为63.6%(21/33)、依赖透析率为18.2%(6/33)。常规CRRT 组的启动时机在诊断CRS 后为94.0(43.5,183.5)h；低血压的发生率为57.6%(19/33)；血管活性药的应用为54.5%(18/33)；住院死亡率为45.4%(15/33)、脱离透析率为27.3%(9/33)、依赖透析率为27.3%(9/33)。2 组患者的CRRT 启动时机(Z=-6.989, P＜0.001)、低血压的发生率(F=6.203,P=0.013)、血管活性药的应用(F=7.791,P=0.013)、住院死亡率(F=5.657,P=0.017)和脱离透析率(F=8.800,P=0.003)有统计学差异(P＜0.05)。多因素Logistic 逐步回归分析显示，CRRT 的启动时机(OR=15.15；95% CI：1.15～200.00；P= 0.039)、单位时间除水量(OR=47.13；95% CI：2.48～893.90；P=0.010)和低血压的发生(OR=83.61；95% CI：5.47～1278.40；P=0.001)是死亡及依赖透析的独立危险因素。结论1 型CRS 的患者早期启动CRRT 并进行精确的容量评估及动态监控，可有效维持血液流力学稳定，挽救心肾功能，降低死亡率。

关键词: 1型心肾综合征, 连续性肾替代治疗, 容量平衡

Abstract: 【Abstract】Objectives To evaluate the effect of goal- directed continuous renal replacement therapy (GD-CRRT) and continuous renal replacement therapy (CRRT) on the prognosis of patient with type 1 cardiorenal syndrome (CRS). Methods A total of 33 cases with type 1 CRS admitted to Beijing Anzhen Hospital
from January 2015 to December 2017 and treated with GD-CRRT were enrolled in the present study. Thirtythree type 1 CRS cases admitted from January 2010 to December 2017 receiving regular CRRT were selected as matched control. Prognosis including mortality rate and hemodialysis withdrawal or hemodialysis dependence was analyzed and compared between the two groups. Results In GD-CRRT group, the initiation of GD-CRRT was 15.0 h (10.0, 22.5 h) after diagnosis of CRS; the incidence of hypotension was 27.3% (9/33); the application of vasoactive drugs was 21.2% (7/33); the in-hospital mortality, rate of hemodialysis withdrawal and rate of hemodialysis dependence were 18.2% (6/33), 63.6% (21/33) and 18.2% (6/33), respectively. In matched control of CRRT group, the initiation of CRRT was 94.0h (43.5, 183.5 h) after diagnosis of CRS; the incidence of hypotension was 57.6% (19/33); the application of vasoactive drugs was 54.5% (18/33); the inhospital mortality, rate of hemodialysis withdrawal and rate of hemodialysis dependence were 45.4% (15/33),
27.3% (9/33) and 27.3% (9/33), respectively. There were significant differences in time interval between CRS diagnosis and treatment (Z=-6.989, P＜0.001), incidence of hypotension (F=6.203, P=0.013), use of vasoactive agents (F=7.791, P=0.013), in-hospital mortality (F=5.657, P=0.017) and rate of hemodialysis withdrawal (F=8.800, P=0.003) between GD-CRRT group and CRRT group (P＜0.05). Multivariate logistic stepwise regression analyses showed that the time interval between CRS diagnosis and treatment (OR=15.15, 95% CI 1.15～200.00, P=0.039), ultrafiltration per unit time (OR=47.13, 95%CI 2.48～893.90, P=0.010) and incidence of hypotension (OR=83.16, 95%CI 5.47～1278.40, P=0.001) were the independent risk factors for death and hemodialysis dependence. Conclusions Patients with type 1 CRS who were treated with early CRRT, accurate volume assessment and dynamic monitoring can effectively maintain the stability of hemodynamics, improve cardiorenal functions and reduce mortality.

Key words: type 1 Cardiorenal syndrome, Continuous renal replacement therapy, Volume balance