中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (12): 910-914.doi: 10.3969/j.issn.1671-4091.2024.12.006

• 临床研究 • 上一篇    下一篇

重症急性胰腺炎患者连续性肾脏替代治疗后累积液体平衡与预后的关系

陈永康    戴晓荣    闫坤锋    陈 磊   

  1. 225400 泰兴，1泰兴市人民医院消化内科
  • 收稿日期:2024-05-06 修回日期:2024-08-07 出版日期:2024-12-12 发布日期:2024-12-12
  • 通讯作者: 陈磊 E-mail:CYKCYK20330@126net.com.cn
  • 作者简介:457606990@qq.com

The relationship between cumulative fluid balance and prognosis after continuous renal replacement therapy in patients with severe acute pancreatitis

CHEN Yong-kang, DAI Xiao-rong, YAN Kun-feng, CHEN Lei   

  1. Department of Gastroenterology, Taixing People's Hospital, Taixing 225400, China
  • Received:2024-05-06 Revised:2024-08-07 Online:2024-12-12 Published:2024-12-12
  • Contact: 225400 泰兴，1泰兴市人民医院消化内科 E-mail:CYKCYK20330@126net.com.cn

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摘要： 目的 探究重症急性胰腺炎(severe acute pancreatitis,SAP)患者连续性肾脏替代治疗(continuous renal replacement treatment,CRRT)后累积液体平衡(cumulative fluid balance,CFB)与预后的关系。 方法 选择2020年3月—2023年3月于泰兴市人民医院就诊的SAP患者248例作为研究对象，采用计算机产生随机数法以2:1的比例分为训练集(n=165)和验证集(n=83)。依据训练集患者CRRT后预后情况将其分为生存组(n=113)和死亡组(n=52)。比较2组患者的一般资料和治疗后7天内的CFB。分析SAP患者CRRT治疗后死亡的影响因素，并分析CFB3与患者治疗后生存情况之间的剂量关系。 结果 治疗后7天，死亡组患者CFB3(t=126.906,P=0.263)、CFB4(t=149.141,P=0.409)、CFB5(t=163.673,P＜0.001)、CFB6(t=158.426,P＜0.001)、CFB7(t=373.539,P＜0.001)均高于生存组。多因素COX回归分析显示：住院期间CRRT总时长(HR=2.864，95% CI：1.042～4.057,P=0.034)、降钙素原(PCT)(HR=3.628，95% CI：2.605～5.231,P=0.016)和CFB3(HR =2.743，95% CI：1.536～3.967,P=0.008)是SAP患者CRRT治疗后死亡的独立危险因素，白蛋白(ALB)(HR =0.726，95% CI：0.532～0.965,P=0.024)为保护因素。对SAP患者预后影响排名前4的因素为CFB3、住院期间 CRRT总时长、ALB、PCT。限制性立方样条模型分析显示：无论男性或女性，CFB3与SAP患者CRRT治疗后死亡风险的关联强度均不存在非线性剂量-反应关系。 结论  SAP患者行CRRT后CFB过量可增加死亡风险，CFB3是患者预后不良的独立危险因素。

关键词: 重症急性胰腺炎, 连续性肾脏替代治疗, 累积液体平衡, 预后

Abstract: Objective  To explore the relationship between cumulative fluid balance (CFB) and prognosis after continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP).  Methods  A total of 248 SAP patients treated in our hospital from March 2020 to March 2023 were selected as the research subjects. Computer-generated random number method was used to divide them into a training set (n=165) and a validation set (n=83) in a 2:1 ratio. According to the prognosis of CRRT patients in the training set, they were divided into a survival group (n=113) and a death group (n=52). General information and CFB within 7 days after treatment were compared between the two groups. The influencing factors for mortality in SAP patients after CRRT treatment and the dose relationship between CFB3 and patient survival after treatment were analyzed.  Results  After 7 days of treatment, the death group had higher levels of CFB3 (t=126.906, P=0.263), CFB4 (t=149.141, P=0.409), CFB5 (t=163.673, P＜0.001), CFB6 (t=158.426, P＜0.001), and CFB7 (t=373.539, P＜0.001) compared to the survival group. Multivariate Cox regression analysis showed that total duration of CRRT during hospitalization (HR=2.864, 95% CI:1.042～4.057, P=0.034), procalcitonin (PCT) (HR=3.628, 95% CI:2.605～5.231, P=0.016), and CFB3 (HR=2.743, 95% CI:1.536～3.967, P=0.008) were the independent risk factors for mortality in SAP patients after CRRT treatment, while albumin (ALB) (HR=0.726, 95% CI:0.532～0.965, P=0.024) was a protective factor. The top 4 factors that affect the prognosis of SAP patients were CFB3, total duration of CRRT during hospitalization, ALB and PCT. Restrictive cubic spline model analysis showed that there was no non-linear dose-response relationship between CFB3 and the risk of death after CRRT treatment in SAP patients, regardless of gender.  Conclusion  Excessive CFB after CRRT in SAP patients can increase the risk of death, and CFB3 is an independent risk factor for poor prognosis. 

Key words: Severe acute pancreatitis, Continuous renal replacement therapy, Cumulative fluid balance, Prognosis

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