心肺复苏后急性肾衰竭的患病率及决定因素

Prevalence and determinants of acute renal failure following cardiopulmonary resuscitation.

作者信息

Mattana J, Singhal P C

机构信息

Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY.

出版信息

Arch Intern Med. 1993 Jan 25;153(2):235-9.

PMID:8422211

Abstract

BACKGROUND

The purpose of this study was to determine the prevalence and determinants of acute renal failure in patients following cardiac arrest.

METHODS

This was a cross-sectional study of 420 consecutive admissions with a diagnosis of cardiac arrest admitted to the Long Island Jewish Medical Center, New Hyde Park, NY, the Long Island Campus for the Albert Einstein College of Medicine, Bronx, NY, over a 2-year period. Fifty-six patients who initially survived cardiopulmonary resuscitation following cardiac arrest and had serial biochemical and renal function data available were studied. The events during cardiopulmonary resuscitation and clinical and biochemical data were compared and contrasted among patients who developed acute renal failure following cardiopulmonary resuscitation (group 1, n = 16) and those who did not (group 2, n = 40).

RESULTS

Patients who developed acute renal failure following cardiopulmonary resuscitation (group 1) had longer duration of resuscitation (12.0 +/- 2.1 minutes vs 6.7 +/- 0.9 minutes for group 2) and received larger dosages of epinephrine during cardiopulmonary resuscitation (1.81 +/- 0.36 mg vs 0.90 +/- 0.18 mg for group 2). Patients in group 1 had a significantly higher frequency of congestive heart failure (43.8% vs 12.5% for group 2), coronary artery disease (87.5% vs 37.5% for group 2), and preexisting compromised renal function (50% vs 12.5% for group 2). Patients in group 1 had significantly worsened long-term survival compared with group 2 patients (6.3% vs 47.5% for group 2).

CONCLUSIONS

We conclude that acute renal failure occurs commonly in the postcardiac arrest period. Administration of the vasoconstrictor epinephrine, congestive heart failure, coronary artery disease, and preexisting renal insufficiency may be significant risk factors for the development of postcardiac arrest acute renal failure. The development of acute renal failure following cardiopulmonary resuscitation predicts a lesser likelihood of survival to discharge from the hospital.

摘要

背景

本研究的目的是确定心脏骤停患者急性肾衰竭的患病率及其决定因素。

方法

这是一项横断面研究，对纽约州新海德公园市长岛犹太医疗中心（隶属于纽约州布朗克斯区阿尔伯特·爱因斯坦医学院长岛校区）在两年期间连续收治的420例诊断为心脏骤停的患者进行研究。对56例心脏骤停后最初心肺复苏成功且有系列生化和肾功能数据的患者进行研究。比较并对比心肺复苏后发生急性肾衰竭的患者（第1组，n = 16）和未发生急性肾衰竭的患者（第2组，n = 40）在心肺复苏期间的事件以及临床和生化数据。

结果

心肺复苏后发生急性肾衰竭的患者（第1组）复苏持续时间更长（第1组为12.0±2.1分钟，第2组为6.7±0.9分钟），且在心肺复苏期间接受肾上腺素的剂量更大（第1组为1.81±0.36毫克，第2组为0.90±0.18毫克）。第1组患者充血性心力衰竭的发生率显著更高（第1组为43.8%，第2组为12.5%）、冠状动脉疾病的发生率显著更高（第1组为87.5%，第2组为37.5%）以及既往肾功能不全的发生率显著更高（第1组为50%，第2组为12.5%）。与第2组患者相比，第1组患者的长期生存率显著更差（第1组为6.3%，第2组为47.5%）。