摘要
目的探讨心脏移植术后连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的影响因素。方法回顾性分析2018年4月至2022年12月在郑州市第七人民医院行心脏移植145例受者的临床资料。根据术后是否行CRRT,分为非CRRT组(124例)和CRRT组(21例)。采用t检验、χ^(2)检验或秩和检验对比分析两组受者的基线资料、术中术后一般情况,将单因素分析中P<0.05的变量和以往研究中有统计学意义的指标纳入多因素logistic回归分析心脏移植术后行CRRT的影响因素;通过绘制受试者操作特征(receiver operating characteristic,ROC)曲线选择最佳的预测界限值。结果145例心脏移植受者中,发生急性肾损伤66例(45.52%),术后需行CRRT者21例(14.48%)。单因素分析结果显示,CRRT组术前估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)水平、红细胞计数、血小板计数、血红蛋白、总胆红素,术中出血量、输血量、尿量,手术时间、体外循环时间,术后机械通气时间、ICU住院时间、术后发生急性肾损伤情况与非CRRT组比较,差异均有统计学意义(P值均<0.05)。多因素logistic回归分析显示,术前血红蛋白水平(OR=0.869,95%CI:0.770~0.980,P=0.022)、术前血小板计数(OR=0.959,95%CI:0.925~0.993,P=0.019),术中出血量(OR=1.004,95%CI:1.000~1.009,P=0.049)、术中尿量(OR=0.997,95%CI:0.993~1.000,P=0.035)、手术时间(OR=1.022,95%CI:1.000~1.044,P=0.047),机械通气时间(OR=1.036,95%CI:1.005~1.069,P=0.024)是心脏移植术后CRRT的独立影响因素。ROC曲线提示,手术时间、机械通气时间及术中出血量对于预测是否行CRRT有重要意义,AUC分别为0.745(95%CI:0.636~0.855)、0.835(95%CI:0.735~0.934)和0.669(95%CI:0.506~0.830);截断值分别为283.5 min、25.46 h和825 ml,灵敏度分别为0.714、0.857和0.571,特异度分别为0.710、0.685和0.895。结论术前血红蛋白水平、血小板计数,术中出血量、尿量、手术时间,术后机械通气时间是心脏移植术后CRRT的独立影响因素。手术时间>283 min、机械通气时间>25.46 h、术中出血量>825 ml对心脏移植术后CRRT具有预测价值。
Objective To explore the influencing factors of continuous renal replacement therapy(CRRT)after heart transplantation(HT).Methods For this retrospective cohort study,the relevant clinical data were retrospectively reviewed for 145 recipients undergoing HT at No.7 Municipal People's Hospital from April 2018 to December 2022.They were assigned into two groups of non-CRRT(n=124)and CRRT(n=21).And t,χ^(2)or rank-sum test was utilized for comparing baseline data,intraoperative and postoperative general conditions of two groups.Variables with P<0.05 in univariate analysis and significant indicators in previous studies were included in multivariate logistic regression analysis to analyze the influencing factors of CRRT post-HT.Receiver operating characteristic curve(ROC)was utilized for selecting the optimal predictive cut-off value.Results Among them,66 cases(45.52%)developed AKI and 21(14.48%)required CRRT.Through univariate analysis,preoperative estimated glomerular filtration rate(eGFR),erythrocyte count,platelet,hemoglobin,total bilirubin,intraoperative volume of blood loss,volume of blood transfusion,urine volume,operative duration,cardiopulmonary bypass time,postoperative mechanical ventilation time,ICU stay and postoperative acute kidney injury were compared.The inter-group differences were statistically significant(P<0.05).Further multivariate logistic regression analysis revealed that preoperative hemoglobin level(OR=0.869,95%CI:0.770-0.980,P=0.022),preoperative platelet count(OR=0.959,95%CI:0.925-0.993,P=0.019),intraoperative volume of hemorrhage(OR=1.004,95%CI:1.000-1.009,P=0.049),intraoperative urine volume(OR=0.997,95%CI:0.993-1.000,P=0.035),operative duration(OR=1.022,95%CI:1.000-1.044,P=0.047)and mechanical ventilation time(OR=1.036,95%CI:1.005-1.069,P=0.024)were the independent influencing factors of CRRT post-HT.ROC curve results indicated that area under curve(AUC)of operative duration,mechanical ventilation time and intraoperative volume of hemorrhage were 0.745(95%CI:0.636-0.855),0.835(95%CI:0.735-0.934)and 0.669(95%CI:0.506-0.830)with a sensitivity of 0.714,0.857,0.571 and a specificity of 0.710,0.685,0.895.And the cut-off values were 283.5 min,25.46 h and 825 ml respectively.Conclusions Hemoglobin level,preoperative platelet count,intraoperative volume of hemorrhage,urine volume,operative duration,mechanical ventilation time and intraoperative urine volume are independent influencing factors of CRRT post-HT.Operative duration>283 min,mechanical ventilation time>25.46 h and intraoperative volume of hemorrhage>825 ml have some predictive values for CRRT post-HT.
作者
武相
王长安
刘金瑞
周强
吴秋杰
王鹏鸽
张靖华
Wu Xiang;Wang Chang'an;Liu Jinrui;Zhou Qiang;Wu Qiujie;Wang Pengge;Zhang Jinghua(Graduate School,Xinxiang Medical University,Xinxiang 453003,China;Kidney Transplant Nephrology Centre,No.7 Municipal People's Hospital,Zhengzhou 450016,China;Heart Transplantation Center,No.7 Municipal People's Hospital,Zhengzhou 450016,China;No.7 Municipal People's Hospital)
出处
《中华器官移植杂志》
CAS
2023年第12期728-734,共7页
Chinese Journal of Organ Transplantation
基金
河南省医学科技攻关计划项目(LHGJ20220842)。
关键词
心脏移植
连续性肾脏替代治疗
急性肾损伤
影响因素
Heart transplantation
Continuous renal replacement therapy
Acute kidney injury
Influence factors
作者简介
通信作者:张靖华,Email:zhangjinghua_59315@163.com。
