【摘要】目的评价体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)联合连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)合并急性肾损伤(acute kidney injury,AKI)患者预后的危险因素。方法 回顾性分析2016年10月～2020年10月华中科技大学同济医学院附属同济医院重症监护病房收治的ECMO联合CRRT治疗的重度ARDS合并AKI患者临床资料。根据患者28天存活情况分为存活组和死亡组，比较2 组患者治疗过程中的临床特征。采用非条件logistic 回归分析评价影响患者预后的危险因素。结果共有54例患者纳入本研究，其中存活组26例，死亡组28例。存活组患者入组时序贯器官衰竭评分(sequential organ failure assessment, SOFA) 低于死亡组(11.8 ± 2.4 比13.7 ± 1.9, t=- 2.550, P=0.015)，ECMO 后CRRT 启动时间明显短于死亡组(4.7±3.3h 比11.4±6.7h,t=-3.024,P=0.005)。存活组患者第3 天液体正平衡量明显低于死亡组(373±210ml 比987±482ml,t=-4.990,P=0.001)。ECMO 后CRRT 启动时间，第3 天液体正平衡量以及SOFA 评分与患者生存率密切相关(OR 95% CI)分别为0.254(0.085～0.656),0.302(0.025～0.498),0.467(0.217～0.887)；P 值分别为0.009, 0.012,0.029)。结论对于ECMO 联合CRRT 治疗的重度ARDS 合并AKI 患者，CRRT 启动的时间，第3 天液体正平衡量以及SOFA评分是患者发生死亡的独立影响因素。
【Abstract】Objective To evaluate the clinical characteristics and risk factors affecting the outcome of severe acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) patients treated with extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT). Methods The severe ARDS and AKI patients required ECMO and CRRT and treated in the Intensive Care Unit (ICU) of Tongji Hospital from October 2016 to October 2020 were retrospectively studied. Clinical characteristics of the patients were analyzed. According to the survival situation within 28 days after VV-ECMO treatment, the patients were divided into survival group and death group. We compared the clinical data of the two groups at the time transferred to ICU, before and after VV-ECMO and CRRT treatment. Unconditioned logistic regression analysis was carried out to determine the independent prognostic risk factors. Results Fiftyfour patients were enrolled in the study, of whom 26 patients survived and 28 patients died. Compared with the death group, the sequential organ failure assessment (SOFA) of the survival group was significantly lower (11.8±2.4 vs. 13.7±1.9, t=-2.550, P=0.015), and the ECMO to CRRT interval was significantly shortened (4.7±3.3h vs. 11.4±6.7h, t=-3.024, P=0.005). During treatment processes, the fluid balance at ECMO day 3 in the
survival group was statistically reduced than death group (373±210ml vs. 987±482ml, t=-4.990, P=0.001). Unconditioned logistic regression analysis showed that the ECMO to CRRT interval, the fluid balance at ECMO day 3, and the SOFA score were the independent risk factors affecting patient prognosis (OR=0.254, 0.302 and 0.467, respectively; 95% CI=0.085～0.656, 0.025～0.498 and 0.217～0.887, respectively; P=0.009, 0.012 and 0.029, respectively). Conclusions The prognosis of severe ARDS and AKI patients required ECMO combined with CRRT depends mainly on the ECMO to CRRT interval, the fluid balance at ECMO day 3 and the SOFA score.
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