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目的:对常规治疗无效的心肾综合征(CRS)可用连续性肾脏替代治疗(CRRT),通过回顾性观察性研究,描述接受CRRT治疗的1型CRS患者的起始特征、终止特征及预后。方法:本研究纳入2009年5月至2015年4月在南京医科大学第一附属医院住院并行CRRT治疗的1型CRS患者。按患者90d是否死亡或是否摆脱透析分为摆脱透析组、透析依赖组和死亡组。记录3组患者一般情况、心肾功能、合并症、CRRT前用药、CRRT起始特征(血清肌酐、血清尿素氮、尿量、出入量平衡)、终止特征和预后,并使用单因素和多因素COX回归分析患者死亡的危险因素。结果:研究纳入52例患者,男性27例、女性25例,平均年龄70.7±16.1岁。平均APACHEⅡ评分为14.4±4.2,平均SOFA评分为8.7±4.7。52例患者死亡率为65.4%。摆脱透析患者开始CRRT前中位尿量及出入量平衡(入量-出量)与透析依赖组、死亡组有明显差异。摆脱透析患者终止CRRT时中位尿量、出入量平衡显著大于透析依赖组(P<0.05)。多因素COX回归分析显示低左室射血分数、低血清白蛋白、高APACHEⅡ评分和出入量正平衡是死亡的独立危险因素。结论:需行CRRT的1型CRS患者预后差,死亡的独立危险因素包括营养状况、心功能、疾病严重程度和容量平衡,死亡组相比存活组在治疗前液体正平衡更明显。尿量至少达到1 000 ml/24h、容量达负平衡时可考虑终止CRRT。
OBJECTIVES: Continuous renal replacement therapy (CRRT) can be used to treat cardiorenal syndrome (CRS) ineffective for conventional therapy. The retrospective observational study describes the onset, termination, and prognosis of CRRT-treated CRS1 patients. Methods: This study included patients with type 1 CRS who underwent CRRT at the First Affiliated Hospital of Nanjing Medical University from May 2009 to April 2015. Patients were divided into dialysis group, dialysis dependent group and death group according to whether the patients were dead or whether they got rid of dialysis. Cardiac and renal function, comorbidities, pretreatment CRRT, initial features of CRRT (serum creatinine, serum urea nitrogen, urine output, balance of access), termination of features and prognosis were recorded in 3 groups of patients, using single and multiple factors COX regression analysis of risk factors for death in patients. Results: The study included 52 patients, 27 males and 25 females, with an average age of 70.7 ± 16.1 years. The average APACHE II score was 14.4 ± 4.2, the mean SOFA score was 8.7 ± 4.7.52 and the mortality rate was 65.4% in 2 patients. Dialysis patients out of dialysis before the beginning of CRRT urine output and balance of access (balance - volume) and dialysis dependent group, the death group were significantly different. Dialysis patients out of the median CRRT urine output, the balance of access was significantly greater than dialysis dependent group (P <0.05). Multivariate Cox regression analysis showed that low left ventricular ejection fraction, low serum albumin, high APACHE II score and the positive balance were the independent risk factors of death. CONCLUSIONS: Patients with type 1 CRS requiring CRRT have poor prognosis and independent risk factors for death include nutritional status, cardiac function, severity of disease, and volume balance. Positive fluid balance is more pronounced in the dead than in the surviving group. Urine volume of at least 1 000 ml / 24h, volume negative balance may consider termination of CRRT.