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体外膜肺氧合患者急性肾损伤的危险因素:系统评价和荟萃分析。

Risk Factors of Acute Kidney Injury in ECMO Patients: A Systematic Review and Meta-Analysis.

机构信息

Department of Nephrology, 66366Zhongshan Hospital Xiamen University, Xiamen, China.

出版信息

J Intensive Care Med. 2022 Feb;37(2):267-277. doi: 10.1177/08850666211003485. Epub 2021 Mar 25.

Abstract

PURPOSE

Acute kidney injury (AKI) is one of the most common complications in patients receiving extracorporeal membrane oxygenation (ECMO), but there is no systematic analysis regarding its risk factors. This meta-analysis aims to determine the risk factors of AKI in adult patients with ECMO treatment.

METHODS

Two authors independently carried out a systemic literature search using PubMed, Web of Science, and Embase until April 20, 2020 (inclusive) to enroll 12 studies reporting the necessary clinical characteristics. The Gender (male), age, APACHE II score, SOFA score, cancer, diabetes mellitus (DM), intra-aortic balloon pump (IABP), postcardiotomy, and ECMO supporting duration were pooled for further analysis by STATA.

RESULTS

Adult patients receiving ECMO who develop AKI and severe AKI incidents are usually older or have a higher APACHE II scores; in addition, severe AKI is related to higher SOFA scores, DM, and longer duration of ECMO support.

CONCLUSIONS

Patients with these clinical characteristics should be paid more attention during ECMO. There remains a need for additional studies to validate these conclusions and to detect additional AKI risk factors for ECMO patients.

摘要

目的

急性肾损伤(AKI)是体外膜肺氧合(ECMO)治疗患者最常见的并发症之一,但目前尚无关于其危险因素的系统分析。本荟萃分析旨在确定 ECMO 治疗成人患者 AKI 的危险因素。

方法

两名作者独立使用 PubMed、Web of Science 和 Embase 进行系统文献检索,检索时间截至 2020 年 4 月 20 日(包括当日),共纳入 12 项报告必要临床特征的研究。采用 STATA 软件对性别(男性)、年龄、急性生理与慢性健康评分 II(APACHE II)评分、序贯器官衰竭评估(SOFA)评分、癌症、糖尿病(DM)、主动脉内球囊反搏(IABP)、心脏手术后、以及 ECMO 支持时间进行汇总分析。

结果

发生 AKI 和严重 AKI 事件的 ECMO 治疗成人患者通常年龄较大或 APACHE II 评分较高;此外,严重 AKI 与较高的 SOFA 评分、DM 和较长的 ECMO 支持时间有关。

结论

在 ECMO 治疗过程中,应更加关注具有这些临床特征的患者。还需要进一步的研究来验证这些结论,并发现 ECMO 患者的其他 AKI 危险因素。

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