Prognostic Analysis Of Continuous Renal Replacement Therapy For Acute Renal Injury In Adults After Cardiovascular Surgery With Extracorporeal Circulation

Objective: To analyze the related factors influencing the prognosis of adult patients with acute renal injury(AKI)needing continuous renal replacement therapy(CRRT)after cardiovascular surgery with extracorporeal circulation.And,to explore the clinical therapeutic effect of early application of CRRT.Methods: The clinical data of 128 patients who had received CRRT after cardiovascular surgery with extracorporeal circulation from January 2013 to November 2019 in our hospital were collected.After screening,the perioperative clinical data of 76 patients who met the inclusion criteria were analyzed retrospectively.According to the prognosis conditions of patients at discharge,they were divided into the survival group and death group,and recorded their main diseases and main types of operations.We analyzed the preoperative,intraoperative and postoperative clinical data and indexes of the two groups,and identified risk factors affecting the prognosis of patients by statistical analysis.In addition,according to the standards of AKI in the KDIGO guidelines,we divided the patients with stage 1 and 2 of AKI into the early CRRT group and patients with stage 3 of AKI into the late CRRT group.We compared the mortality,APACHE II score within 24 hours before CRRT,the time from post-operation to the beginning of CRRT and CRRT duration between the two groups.Then,we analyzed the changes in relevant clinical indexes from each group.Heart rate,mean arterial pressure,blood urea nitrogen,serum creatinine,blood lactic acid and serum potassium were determined before and 24,48,72 hours after CRRT.Results: Among the 76 patients,30 patients died and the mortality rate was 39.5%.The main types of operations included heart valve surgery,aortic surgery,coronary artery bypass grafting,cardiac surgery for congenital heart disease,coronary artery bypass grafting combined with heart valve surgery,excision of left atrial myxoma combined with coronary artery bypass grafting.There was statistical difference in the following factorsbetween the death group and the survival group: age,preoperative white blood cell count,operative time,the volume of intraoperative plasma transfusion,APACHE II score,the use of IABP,the stage of AKI,serum creatinine before CRRT,blood lactic acid before CRRT,the length of stay in ICU and hospitalization time(P<0.05).Through multivariate Logistic regression analysis,it was found that the independent risk factors affecting the prognosis of patients treated with CRRT were APACHE II score,the stage of AKI and serum creatinine before CRRT.The mortality rate of patients in the early CRRT group was lower than that in the late CRRT group.There was a statistically significant difference in mortality and APACHE II score within 24 hours before CRRT between the two groups(P<0.05).At 48 and 72 hours after CRRT,there was a significant improvement in the heart rate,blood lactic acid,blood urea nitrogen,serum creatinine,blood potassium level and mean arterial pressure in both groups(P<0.05),but the measured values of the same indexes in the late CRRT group were generally higher than those in the early CRRT group at the same monitoring time after CRRT.Conclusion: The APACHE II score within 24 hours after admission to ICU,the stage of AKI and serum creatinine level before CRRT may be the independent risk factors affecting the prognosis of adult patients with AKI needing CRRT after cardiovascular surgery.Early initiation of CRRT may improve the survival rate of patients.