危重患者急性肾功能不全死亡相关因素分析

目的 :探讨影响急性肾功能不全的危重病患者预后的相关因素。方法 :回顾 1999年 8月— 2 0 0 1年5月北京协和医院加强医疗科 (ICU)收治的危重患者合并急性肾功能不全的资料 ,对住院死亡的高危因素进行分析。结果 :收治的 12 18例危重患者中 ,急性肾功能不全者 14 9例 ,其中病历资料完全者 13 5例 (随访率91% )。住院期间死亡 5 5例 (4 1% )。单因素分析发现 ,全身炎症反应综合征 (SIRS)、全身性感染、严重全身性感染、感染性休克、慢性呼吸功能不全、应用去甲肾上腺素、应用持续静静脉血液滤过 (CVVH)治疗、急性生理和慢性健康状况 (APACHE )评分、全身感染性相关器官功能衰竭 (SOFA)评分是急性肾功能不全患者死亡的危险因素 (P均 <0 .0 5 ) ;而 APACHE 评分、应用去甲肾上腺素和 CVVH是死亡的独立危险因素 (P均 <0 .0 5 )。结论 :急性肾功能不全患者的预后与基础疾病的严重程度相关 ,主要包括少尿、出凝血障碍、中枢神经系统功能不全和全身性感染。虽然应用 CVVH治疗 ,急性肾功能不全本身仍然可使危重患者的病死率升高

Analysis of factors related to mortality of critical patients with acute renal dysfunction

OBJECTIVE: To investigate the high risk factors related to mortality rate of critical patients with acute renal dysfunction in intensive care unit (ICU). METHODS: The data of patients with acute renal dysfunction hospitalized in ICU of Peking union medical college hospital during August 1999 to May 2001 were retrospectively investigated and the high risk factors related to hospital mortality were analyzed. The statistical analysis methods were univariate and multivariate factors analysis. RESULTS: Among 1 218 critical patients hospitalized during August 1999 to May 2001, there were 149 patients with acute renal dysfunction. One hundred and thirty-five patients were investigated completely. Fifty-five (41 percent) died during the hospital stay. By univariate analysis, risk factors related to hospital mortality included acute physiology and chronic health evaluationII (APACHEII) score, the systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, chronic respiratory dysfunction, sepsis-related organ failure assessment (SOFA) score, acute respiratory dysfunction, coagulation dysfunction, central nerves system dysfunction, cardiovascular dysfunction, management of noradrenaline and continuous venovenous hemofiltration (CVVH). By multivariate analysis, only APACHEII score and management of noradrenaline and CVVH were determined as risk factors of hospital mortality independently. If the three factors were excluded, sepsis, central nerves system dysfunction, oliguria became the risk factors of mortality (all P<0.05). CONCLUSION: The prognosis of critical patients with the acute renal dysfunction correlate with degree of basic diseases. There include oliguresis, coagulation dysfunction, central nerves system dysfunction and sepsis. In spite of management of CVVH, acute renal dysfunction per se can affect the prognosis of the critical patients.