目的 探讨心脏手术后合并脓毒血症相关急性肾损伤(sepsis-associated acute kidney injury，SA-AKI)患者的30 d预后。 方法 采用回顾性队列研究设计，收集2023年3月—2024年5月在广东省人民医院进行心脏手术后行连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)的成人患者临床资料。根据患者心脏手术后7 d内是否发生脓毒血症相关急性肾损伤分为SA-AKI组和急性肾损伤(acute kidney injury，AKI)组。 结果 共纳入239例患者，平均年龄(57.4±13.5)岁，男性157例(65.7%)。SA-AKI组(n=43)序贯器官衰竭评分(sequential organ failure assessment，SOFA)高于AKI组(n=196)(t=-2.534，P=0.014)。患者总体死亡率31.4%(75/239)，CRRT中位治疗时间8.0(3.0,17.0)d。SA-AKI组患者死亡率高于AKI组(62.8%比24.5%，χ2=-4.747，P＜0.001)。Kaplan-Meier生存分析显示SA-AKI组患者累积死亡率高于AKI组(HR =1.959，95% CI：1.220～3.145，P=0.004)。重复测量方差分析显示SA-AKI组与AKI组SOFA评分组间差异有统计学意义(F=8.135，P=0.004)，存在时间趋势(F=4.441，P＜0.001)。SA-AKI组与AKI组血乳酸均有降低趋势，组间差异不显著(F=1.543，P=0.215)。SA-AKI组与AKI组平均动脉压组间存在差异(F=9.028，P=0.002)，无时间趋势(F=0.589，P＜0.739)。死亡组患者SOFA评分高于生存组(F=61.036，P＜0.001)，血乳酸高于生存组(F=14.853，P＜0.001)，平均动脉压低于生存组(F=45.056，P＜0.001)。 结论 心脏手术后发生脓毒血症相关急性肾损伤的患者30 d死亡风险显著增加。CRRT治疗的第1周内需要关注病情变化，尤其需要加强监测SOFA评分、乳酸水平和血流动力学指标的变化趋势。
廖俊杰
,
宋利
,
尹燕
,
张逸婷
,
陈诚
,
全梓林
,
梁馨苓
,
冯仲林
,
叶智明
. 心脏手术后合并脓毒血症相关急性肾损伤患者行连续性肾脏替代治疗预后情况[J]. 中国血液净化, 2025
, 24(07)
: 554
-558
.
DOI: 10.3969/j.issn.1671-4091.2025.07.003
Objective To investigate the 30 day prognosis of adult patients who underwent continuous renal replacement therapy (CRRT) after cardiac surgery and developed sepsis-associated acute kidney injury (SA-AKI). Methods A retrospective cohort study was conducted, collecting clinical data from 239 adult patients who underwent CRRT at Guangdong Provincial People's Hospital from March 2023 to May 2024. Patients were divided into two groups based on whether they developed sepsis-associated acute kidney injury within 7 days after cardiac surgery: Acute kidney injury (AKI) group and SA-AKI group. Results A total of 239 adult patients who underwent cardiac surgery were included, with an average age of 57.4±13.5 years, and 157 males (65.7%). The Sequential organ failure assessment (SOFA) score was higher in the SA-AKI group compared to the AKI group, 11.0±3.63 vs. 9.45±3.89, (t=-2.534, P=0.014). The overall mortality rate was 31.4% (75/239), with an average treatment time of CRRT and the interquartile range was 8.0 (3.0,17.0) days. The mortality rate of patients in the SA-AKI group was significantly higher than that in the AKI group, 62.8% vs. 24.5%, (χ2=-4.747, P＜0.001). Kaplan-Meier survival analysis log-rank test showed that the cumulative mortality rate in the SA-AKI group was significantly higher than in the AKI group, HR (95%CI) =1.959 (1.220～3.145), (P=0.004). The repeated-measures analysis showed that there was a significant difference in SOFA scores between the SA-AKI group and the AKI group (P=0.004, F=8.135), and a significant time trend was also observed (P＜0.001, F=4.441). There was a trend towards lower blood lactate levels in both groups, with no significant inter-group differences (P=0.215，F=1.543). There was a significant difference in mean arterial pressure between the SA-AKI group and the AKI group (P=0.002, F=9.028), while the time trend was not significant (P=0.739, F=0.589). Patients in the mortality group had higher SOFA scores than those in the survival group (P＜0.001, F=61.036). The blood lactate levels were higher in the mortality group than that in the survival group (P＜0.001, F=14.853). Additionally, the mean arterial pressure was lower in the mortality group compared with the survival group (P＜0.001, F=45.056). Conclusion Patients who developed sepsis-associated acute kidney injury after cardiac surgery have a significantly increased 30-day mortality risk. During the first week of CRRT treatment, it is important to monitor changes in the condition, especially to strengthen monitoring of trends in SOFA scores, lactate levels, and hemodynamic indicators.
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