CRRT治疗危重型肾综合征出血热的时机及预后影响因素

目的 分析连续性肾脏替代治疗（CRRT）在危重型肾综合征出血热不同时期的疗效及预后影响因素。方法 选取2013年10月—2017年2月行CRRT治疗的135例危重型肾综合征出血热患者作为研究对象,根据行CRRT治疗时间的不同分为低血压休克期组（70例）及少尿期组（65例）。分别研究两组患者临床治愈情况、并发症情况、CRRT治疗时间、重症监护（intensive care unit,ICU）住院时间、住院费用及预后情况,最后采用Logistic回归分析影响经CRRT治疗危重型肾综合征出血热预后的因素。结果 低血压休克期组治愈率（92.86%,65/70）明显高于少尿期组（78.46%,51/65）,差异有统计学意义（P<0.05）;低血压休克期组并发症发生率和死亡率明显低于少尿期组（P<0.05）;低血压休克期组CRRT时间、重症ICU住院时间及住院费用均低于少尿期组（P<0.05）;经单因素分析得知,年龄、身高体重（body mass index, BMI）指数、并发症累计数、CRRT时间及重症ICU住院时间不同,经CRRT治疗的危重型肾综合征出血热预后也不同（P<0.05）;经Logistic回归分析得知,BMI指数≥25及并发症累计数≥4项是影响经CRRT治疗的危重型肾综合征出血热的预后影响因素（P<0.05）。结论 肥胖及多重并发症是经CRRT治疗的危重型肾综合征出血热的危险因素,但早期开始连续性肾脏替代治疗可有效改善危重型肾综合征出血热患者的疗效及预后,值得临床推广。

The timing of treatment and prognostic factors by continuous renal replacement therapy in severe hemorrhagic fever with renal syndrome

Objective To study the prognostic factors and efficacy of continuous renal replacement therapy (CRRT) in patients with severe hemorrhagic fever with renal syndrome at different stages. Methods Totally 135 patients with severe renal syndrome hemorrhagic fever who were underwent continuous renal replacement therapy from October 2013 to February 2017 were collected into this study. 135 patients were divided into early group (70 cases) and middle-late group(65 cases) according to the time of CRRT, respectively. To compare the situation of clinical cure, the complications,the time of continuous renal replacement therapy and hospitalization time of severe ICU, hospitalization cost, the situation of sequential and the prognosis of two groups. To study the influencing factors of prognosis with CRRT in severe renal syndrome by Logistic regression. Results The cure rate of the early group (92.86%, 65/70) was significantly higher than that of the middle-late group（78.46%, 51/65） (P<0.05); the incidence of complications and mortality in the early group were significantly lower than those in the middle-late group (P<0.05); the CRRT time, the hospitalization time and hospitalization costs of the severe ICU group were lower than those of the middle and late group,respectively (P<0.05); The ANOVA analysis showed that age, weight, complications, CRRT time and hospitalization time of severe ICU and the prognosis of severe hemorrhagic fever with renal syndrome was also different between two groups (P<0.05); the logistic regression analysis showed that the BMI≥25 and the incidence of complications≥4 were the risk factors of severe hemorrhagic fever with renal syndrome by CRRT treatment (P<0.05). Conclusion Weight and many kinds of complication are the risk factors with CRRT of severe hemorrhagic fever with renal syndrome, but early continuous renal replacement therapy can effectively improve the curative effect and prognosis of severe hemorrhagic fever with renal syndrome, which is worthy of clinical promotion.