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31例新生儿连续性肾脏替代治疗的临床应用分析

Analysis in clinical application of continuous renal replacement therapy for 31 neonates

    摘要
  • 摘要:
    目的 探讨新生儿连续性肾脏替代治疗(CRRT)滤器凝血的风险因素。
    方法 回顾性分析2020年3月—2025年2月在湖南省儿童医院新生儿重症监护室31例行CRRT的足月新生儿临床资料。滤器存活率采用Kaplan-Meier生存分析，滤器凝血风险因素采用Cox比例风险回归模型分析。
    结果 存活18例(58.1%, 存活组)，死亡13例(41.9%, 死亡组)。CRRT启动适应证主要为脓毒性休克(29.0%)、遗传代谢危象(25.8%)。96.8%患儿CRRT前需机械通气, 93.5%需血管活性药物。新生儿危重病例评分(NCIS)为70.0(66.0, 72.0)分。存活组NCIS、血红蛋白、血小板计数及白蛋白水平均高于死亡组，差异均有统计学意义(均P < 0.05)。滤器寿命为35.0(25.0, 37.0) h。CRRT并发症分别为低血压(25.8%)、导管相关血栓形成(6.5%)和出血事件(6.5%); 无低体温、导管相关感染病例。单因素和多因素Cox回归分析显示，抗凝方式、CRRT期间输红细胞、导管/静脉直径比>0.33均为滤器凝血的独立影响因素(P < 0.05)。无抗凝(HR=7.276, 95%CI: 2.246~23.572, P < 0.001)、CRRT期间输红细胞(HR=3.176, 95%CI: 1.048~9.622, P=0.041)和导管/静脉直径比>0.33(HR=3.486, 95%CI: 1.360~8.933, P=0.009)增加滤器凝血风险。
    结论 CRRT在足月危重新生儿中具有可行性，合理抗凝、谨慎的输血管理以及选择与血管适配导管是优化滤器寿命的关键。

     

    Abstract:
    Objective To investigate the risk factors for filter coagulation during continuous renal replacement therapy (CRRT) in neonates.
    Methods The clinical data of 31 full-term neonates who underwent CRRT in the neonatal intensive care unit of Hunan Children's Hospital from March 2020 to February 2025 were retrospectively analyzed. The filter survival rate was analyzed by the Kaplan-Meier survival analysis, and the risk factors for filter coagulation were analyzed by the Cox proportional hazards regression model.
    Results A total of 18 neonates (58.1%, survival group) survived, while 13 cases (41.9%, non-survival group) died. The main indications for initiating CRRT were septic shock (29.0%) and genetic metabolic crisis (25.8%). Prior to CRRT, 96.8% of the neonates required mechanical ventilation, and 93.5% needed vasoactive drugs.The Neonatal Critical Illness Score (NCIS) was 70.0(66.0, 72.0) points.The NCIS, hemoglobin levels, platelet counts, and albumin levels in the survival group were all significantly higher than those in the non-survival group (all P < 0.05). The filter lifespan was 35.0(25.0, 37.0) hours. The complications of CRRT included hypotension (25.8%), catheter-related thrombosis (6.5%), and bleeding events (6.5%); no cases of hypothermia or catheter-related infection were observed. Univariate and multivariate Cox regression analyses revealed that the anticoagulation method, red blood cell transfusion during CRRT, and a catheter/vein diameter ratio>0.33 were all independent influencing factors for filter coagulation (P < 0.05). The absence of anticoagulation (HR=7.276, 95%CI, 2.246 to 23.572, P < 0.001), red blood cell transfusion during CRRT (HR=3.176, 95%CI, 1.048 to 9.622, P=0.041), and a catheter/vein diameter ratio >0.33 (HR=3.486, 95%CI, 1.360 to 8.933, P=0.009) increased the risk of filter coagulation.
    Conclusion CRRT is feasible in full-term critically ill neonates.Reasonable anticoagulation, prudent transfusion management, and the selection of catheters that match the vascular diameter are crucial for optimizing filter lifespan.

     

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