连续性肾替代治疗在体外膜氧合病人中的应用

胡德亮; 张劲松; 陈旭锋; 梅勇; 吕金如

doi:10.13898/j.cnki.issn.1000-2200.2022.10.007

连续性肾替代治疗在体外膜氧合病人中的应用

Clinical analysis of continuous renal replacement therapy in patients with extracorporeal membrane oxygenation

摘要

摘要:
目的总结连续性肾替代治疗(continuous renal replacement therapy，CRRT)在体外膜氧合(extracorporeal embrane oxygenation，ECMO)病人中的临床经验。
方法搜集124例ECMO支持超过24 h的病人资料，根据是否联合CRRT分为CRRT+ECMO组(n=74)及ECMO组(n=50)，根据CRRT时长分为CRRT < 7 d组(n=30)及CRRT≥7 d组(n=44)；心脏骤停病人52例根据是否联合CRRT分为CRRT+ECMO组(n=38)及ECMO组(n=14)；心脏骤停病人中根据CRRT时长分为CRRT < 7 d组(n=17)及CRRT≥7 d组(n=21)。分别分析各组病人的ECMO辅助时间、有创机械通气时间、住院时间以及出院存活率。
结果124例成年病人中CRRT+ECMO组较单纯ECMO组ECMO辅助时间、有创机械通气时间更长，出院存活率更低(P < 0.05~P < 0.01)，而住院时间差异无统计学意义(P>0.05)；CRRT < 7 d组较CRRT≥7 d组ECMO辅助时间、有创机械通气时间以及住院时间更短，出院存活率更低，差异有统计学意义(P < 0.05~P < 0.01)；心脏骤停病人中CRRT+ECMO组较单纯ECMO组ECMO辅助时间、有创机械通气时间及住院时间差异无统计学意义(P>0.05)，而出院存活率更低(P < 0.01)；心脏骤停病人中CRRT < 7 d组较CRRT≥7 d组ECMO辅助时间、有创机械通气时间以及住院时间更短(P < 0.01)，出院存活率差异无统计学意义(P>0.05)。
结论ECMO支持同时需要CRRT治疗的病人有着更低的出院存活率，可能与其肾损伤更严重有关；对于需要CRRT支持的多数病人而言CRRT支持≥7 d的病人出院存活率较高，而出现心脏骤停的病人CRRT时长与病人存活率无明确关系，需要更大样本研究证实。

Abstract:
ObjectiveTo summarize the clinical experience of continuous renal replacement therapy(CRRT) in patients with extracorporeal membrane oxygenation(ECMO).
MethodsThe clinical data of 124 patients who received ECMO support for more than 24 hours were collected and divided into CRRT+ECMO group(n=74) and ECMO group(n=50) according to whether combined with CRRT.Patients with CRRT were divided into CRRT < 7 d group(n=30) and CRRT ≥ 7 d group(n=44) according to the duration of CRRT, and 52 patients with cardiac arrest were divided into CRRT+ECMO group(n=38) and ECMO group(n=14) according to whether they were combined with CRRT or not.According to the duration of CRRT, the patients with cardiac arrest combined with CRRT were divided into two groups: CRRT < 7 d group(n=17) and CRRT ≥7 d group(n=21).The duration of ECMO treatment, invasive mechanical ventilation, hospital stay and discharge survival rate of the two groups were analyzed respectively.
ResultsAmong 124 adult patients, the duration of ECMO treatment and invasive mechanical ventilation in the CRRT + ECMO group was longer than those in the ECMO group, and the discharge survival rate was lower(P < 0.05 to P < 0.01), but there was no significant difference in hospital stay(P>0.05).Compared with CRRT ≥7 d group, ECMO treatment time, invasive mechanical ventilation time and hospital stay in CRRT < 7 d group were shorter, and the discharge survival rate was lower(P < 0.05).Among the patients with cardiac arrest, there was no significant difference in the duration of ECMO treatment, invasive mechanical ventilation and hospital stay between the CRRT+ECMO group and the ECMO group, but the discharge survival rate was lower in the CRRT+ECMO group(P < 0.01), while the ECMO treatment time, invasive mechanical ventilation time and hospital stay in the CRRT < 7 d group were shorter than those in the CRRT ≥7 d group, there was no significant difference in the discharge survival rate(P>0.05).
ConclusionsPatients with ECMO support and CRRT treatment have lower survival rate, which may be related to severe renal injury.For most patients requiring CRRT support, patients with CRRT support for ≥7 d have a higher survival rate, while patients with cardiac arrest have no clear relationship between CRRT duration and survival, which needs to be confirmed by larger sample studies.

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