连续性肾脏替代治疗的成功撤机。相关危险因素。

Successful weaning from continuous renal replacement therapy. Associated risk factors.

机构信息

Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain.

出版信息

J Crit Care. 2018 Jun;45:144-148. doi: 10.1016/j.jcrc.2018.02.009. Epub 2018 Feb 16.

DOI:10.1016/j.jcrc.2018.02.009

PMID:29477939

Abstract

PURPOSE

To identify risk factors of successful continuous renal replacement therapy (CRRT) weaning and to evaluate the effect of furosemide in the recovery of urine output after CRRT stop.

MATERIALS AND METHODS

Retrospective, observational study of critical patients treated with CRRT. Weaning tests (WT) were classified in two groups: successful (urine output was recovered and CRRT was not required again) and failed (CRRT was required again). A multiple logistic regression model was used to identify risk factors of successful CRRT WT. The prediction ability was assessed with the area under the receiver operating characteristic curves (AUC-ROC).

RESULTS

Eighty-six patients underwent 101 CRRT WT. The multivariate model identified that the risk factors of successful CRRT weaning were sex and 6h-urine output after CRRT stop. The AUC-ROC was 0.81 (0.72-0.90) for 6h-urine output before and 0.91 (0.84-0.96) for 6h-urine output after CRRT stop. The AUC-ROC for 6h-urine output after WT to predict successful CRRT weaning were 0.94 (0.88-1.0) in patients who received furosemide and 0.85 (0.72-0.99) in patients who did not.

CONCLUSIONS

Urine output after CRRT stop was the main risk factor of successful CRRT weaning. Administration of furosemide increased the strength of this association.

摘要

目的

确定连续性肾脏替代治疗（CRRT）撤机成功的危险因素，并评估呋塞米在 CRRT 停止后恢复尿量的效果。

材料与方法

回顾性观察性研究纳入接受 CRRT 治疗的危重症患者。将撤机试验（WT）分为两组：成功组（尿量恢复，不再需要 CRRT）和失败组（再次需要 CRRT）。采用多因素逻辑回归模型确定 CRRT WT 成功的危险因素。采用受试者工作特征曲线下面积（AUC-ROC）评估预测能力。

结果

86 例患者共进行了 101 次 CRRT WT。多因素模型确定 CRRT 撤机成功的危险因素为性别和 CRRT 停止后 6 小时尿量。CRRT 停止后 6 小时尿量的 AUC-ROC 为 0.81（0.72-0.90），而 CRRT 停止前的 AUC-ROC 为 0.91（0.84-0.96）。WT 后 6 小时尿量预测 CRRT 撤机成功的 AUC-ROC 在接受呋塞米的患者中为 0.94（0.88-1.0），在未接受呋塞米的患者中为 0.85（0.72-0.99）。