Related factors of the prognosis in patients with first time receiving continuous renal replacement therapy at surgical intensive care unit
|Keywords:||急性腎損傷衰竭;連續性腎臟替代療法;存活分析;acute renal injury/failure;continuous renal replacement therapy;Kaplan-Meier survival analysis||Issue Date:||2015||Abstract:||
【背景】醫院病患發生急性腎衰竭比率約20％至67％，死亡率約26％，其會提升後續醫療成本。本研究針對加護單位首次接受連續性腎臟替代療法(CRRT)病患的臨床現況、相關因素及預後進行探討，以做將來臨床醫療照護決策的參考。 【目的】了解外科加護病房病患急性腎損傷╱衰竭發生率及預後；了解CRRT病患之基本屬性及疾病特性；分析治療狀態與預後之關係；及探討預後之影響因素。 【研究方法】本研究是屬於描述性、相關性、回溯性研究設計，研究對象為中部某醫學中心外科加護病房(SICU)首次接受連續性腎臟替代療法(CRRT)之病患，查閱2012年01月01日至2013年12月31日期間所有研究對象之病歷，採用結構式個案病歷資料調查表收集資料，以描述性統計及推論性統計進行分析。 【結果】本研究對象共251例，此單位發生CRRT比例為6.4％；SICU住院日數1-73天，離開此單位時53％是死亡；118例存活轉出SICU時，27例(23％)需要依賴血液透析，77％可脫離透析治療。男性、年齡≧70歲及腸胃外科病患發生急性腎損傷╱衰竭之機率高。比較存活者與死亡者發現：入SICU時血清肌酸酐(3.2 vs. 2.1)，RIFLE分級屬RIF等級比例(80% vs. 51%)；入SICU至CRRT間距天數(4.8 vs. 6.7)；CRRT前血清肌酸酐(3.7 vs. 2.9)，未發生休克比例(33% vs. 20%)，無使用呼吸器比例(15% vs. 5%)；兩組皆具顯著差異。比較透析脫離者與依賴者發現：入SICU時血清肌酸酐(2.9 vs. 4.0)，RIFLE分級屬IF等級比例(47% vs. 85%)；入SICU至CRRT間距天數(3.9 vs. 7.9)；CRRT前血清肌酸酐(3.4 vs. 4.7)，未發生休克比例(25% vs. 59%)；兩組皆具顯著差異。入SICU時之血清肌酸酐異常者、入SICU至CRRT間距天數≦2者、CRRT前無使用呼吸器者之存活率皆較高。 【結論】調查於SICU首次執行CRRT之病患，發現男性、年長者、入SICU時APACHEⅡ≧20分者，具有較高急性腎損傷╱衰竭之危險性。完整評估病患之臨床狀況及適時介入連續性腎臟替代療法，可使存活者有較高的機會恢復腎臟功能並脫離血液透析。
Background: Acute renal injury/failure was a common complication among patients who admitted to surgical intensive care unit (SICU). The incidence rate was 20% to 67% and mortality rate was 26%. There was a huge medical cost and spending for follow-up health care. The study focused at related factors and prognosis of SICU patients who first-time receiving continuous renal replacement therapy (CRRT). Objective: To understand the incidence and prognosis of acute renal injury/failure; to understand the characteristics of demographic and disease in patients with CRRT; to analyze the relation between clinical situation and prognosis in patients with CRRT; to explore the related factors of prognosis in patients with CRRT. Method: This study was a retrospective and descriptive correlational design in which data were retrieved from medical charts of patients who first-time receiving CRRT at a medical center SICU in central Taiwan. Data was collected from January 1st, 2012 to December 31st, 2013 by using a self-designed chart-record sheet. The data was analyzed by descriptive statistics and inferential statistics. Results: The incidence rate of CRRT was 6.4% and 251cases were recruited. When the subjects discharged from SICU after 1-73days staying, there were 118 survivals and the mortality rate was 53％. Among survivals, becoming hemodialysis-depended patients were 27 (23％) and the others (77%) were free from dialysis therapy. Male, age≧70 years old and gastro-intestinal surgical patients, they had higher risk to acute renal injury/failure. Comparing the two groups (survivals vs. deaths) in the serum creatinine at SICU admitted (3.2 vs. 2.1 mg/dL), the percentage of belonging RIF levels in RIFLE criteria (80% vs. 51%), the interval of SICU admitted to on-CRRT (4.8 vs. 6.7 days), the serum creatinine at pre on-CRRT (3.7 vs. 2.9 mg/dL), the percentage of non-shock (33% vs. 20%), the percentage of non-using mechanical ventilator (15% vs. 5%). The results showed significant differences between the two groups. The abnormal serum creatinine while admitted to SICU, the interval of SICU admitted to on-CRRT ≦2 days and no mechanical ventilator using at pre on-CRRT, they had higher survival rate. Conclusion: The study found that elder male patients and APACHEⅡscore≧20 had higher risk to acute renal injury/failure. Evaluating patients comprehensively and implementing CRRT at the right moment were important in clinical practice, and then allowed survivors have a higher chance of recovering renal function.
|Appears in Collections:||護理學系所|
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