容量过负荷程度对心脏手术后急性肾损伤接受肾脏替代治疗患者肾脏预后的影响

发布时间：2018-07-15 20:41

【摘要】：目的探讨容量过负荷(FO)程度对心脏手术后急性肾损伤(AKI)接受肾脏替代治疗(RRT)患者总体预后和肾脏预后的影响,以进一步指导心脏手术后AKI患者的液体管理策略。方法收集2009年1月—2014年4月间接受心脏手术后发生AKI并进行RRT(AKI-RRT)的患者143例,存活(存活组)51例(35.7%),死亡(死亡组)92例(64.3%)。绝对FO=总入液量-总出液量,相对FO(%FO)=(总入液量-总出液量)/基础体重×100%。根据患者RRT开始前%FO程度分为RRT前-10%~0组、0~10%组、10%~20%组,根据RRT结束时%FO程度分为RRT后-10%~0组、0~10%组、10%~20%组。结果死亡组与存活组间心脏外科术前、术中、术后相关因素的差异均无统计学意义(P值均0.05)。死亡组手术开始至RRT结束、入ICU至RRT结束时的FO和%FO均显著高于存活组(P值均0.05)。RRT前-10%~0组、RRT前0~10%组的肾功能完全恢复率均显著高于RRT前10%~20%组(P值均0.05),3组间院内病死率、肾功能未恢复率、肾功能部分恢复率的差异均无统计学意义(P值均0.05)。RRT后-10%~0组、RRT后0~10%组的肾功能完全恢复率均显著高于RRT后10%~20%组(P值均0.05),RRT后-10%~0组又显著高于RRT后0~10%组(P0.05);RRT后-10%~0组、RRT后0~10%组的院内病死率均显著低于RRT后10%~20%组(P值均0.05),RRT后-10%~0组又显著低于RRT后0~10%组(P0.05);3组间肾功能未恢复率、肾功能部分恢复率的差异均无统计学意义(P值均0.05)。结论 FO增加心脏手术后AKI-RRT患者的死亡风险,RRT前后的FO不利于肾功能的完全恢复。应进一步重视心脏手术后AKI患者的容量平衡。
[Abstract]:Objective to investigate the effect of volume overload (FO) on the overall prognosis and renal prognosis of patients with acute renal injury (AKI) undergoing renal replacement therapy (RRT) after cardiac surgery. Methods from January 2009 to April 2014, 143 patients underwent AKI and underwent RRT (AKI-RRT), 51 (35.7%) survived (survival group) and 92 (64.3%) died (death group). Absolute FOX = total liquid inflow-total liquid output, relative FO = (total fluid inflow-total fluid output) / base weight 脳 100. According to the degree of FO before the beginning of RRT, the patients were divided into 10% and 20% groups. According to the degree of FO at the end of RRT, they were divided into 10% and 20% groups after RRT. Results there was no significant difference between the death group and the survival group before, during and after cardiac surgery (P < 0.05). FO and FO of death group were significantly higher than those of survival group (P 0.05). The complete recovery rate of renal function in 10% group before RRT was significantly higher than that in 20% group before RRT (P 0.05). No recovery rate of renal function, There was no significant difference in partial recovery rate of renal function (P 0.05). The complete recovery rate of renal function in group -10% after RRT was significantly higher than that in group -10% after RRT (P 0.05) and in group -10% after RRT (P < 0.05). It was also significantly higher in group -10% after RRT than in group -10% after RRT (P0.05). The nosocomial mortality of RRT group was significantly lower than that of RRT 10% group (P 0.05), and that of RRT group -10% group was significantly lower than that of RRT group 0 10% group (P0.05). There was no significant difference in partial recovery rate of renal function (P 0.05). Conclusion FO increases the risk of death in AKI-RRT patients after cardiac surgery. FO before and after RRT is not conducive to the complete recovery of renal function. Further attention should be paid to the volume balance of AKI patients after cardiac surgery.
【作者单位】：复旦大学附属中山医院肾脏科;上海市肾病与透析研究所;上海市肾脏疾病与血液净化重点实验室;复旦大学附属中山医院心外科;
【基金】：国家十二五支撑计划(2011BAI10B07) 上海市科学技术委员会科研计划(12DJ1400201;14DZ2260200)资助项目
【分类号】：R654.2;R692

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