摘要
目的 探讨危重症患者急性肾损伤(AKI)发生的危险因素.方法 采用前瞻性巢式病例对照研究,选择入住某三级甲等综合性医院ICU病房的危重症患者作为队列进行随访,根据是否出现急性肾损伤将其分为病例组和对照组,比较2组患者临床基本特征,采用多因素logistic回归分析危重症患者AKI发生的影响因素.结果 危重症患者符合入选标准进入队列共426人,巢式病例对照研究确定病例组112人,对照组314人.2组患者在性别、年龄、APACHEⅡ评分、肾外器官衰竭个数、重症感染、CKD、高血压、糖尿病、外科手术、动脉氧分压、乳酸、血钙、血肌酐、血小板、血尿素氮、血肌酐、谷草转氨酶、脑钠肽方面比较差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,危重症患者AKI发生的危险因素包括年龄、APACHE II评分、肾外器官衰竭个数、重症感染、CKD、外科手术、血肌酐、脑钠肽,均P<0.001.结论 高龄、高APACHE II评分、肾外器官衰竭、重症感染、CKD、外科手术、血肌酐升高、脑钠肽升高是危重症患者AKI发生的主要危险因素,上述指标异常提示患者发生AKI的风险增加,临床治疗中应对此加以关注,以改善患者预后.
Objective To explore the risk factors of acute kidney injury(AKI)in critically ill patients.Methods In a prospective nested case-control study,critically ill patients who were admitted to the ICU ward of a tertiary hospital were followed up as a cohort.They were divided into the case group and the control group according to the acute kidney injury,and the clinical basic characteristics of both groups were compared.Multivariate logistic regression was used to analyze the influencing factors of AKI in critically ill patients.Results Totally 426 critically ill patients meeting the inclusion criteria entered the cohort,with 112 patients in the case group and 314 patients in the control group.There were significant differences between both groups in gender,age,APACHE II score,number of extrarenal organ failure,severe infection,CKD,hypertension,diabetes,surgery,arterial oxygen partial pressure,lactic acid,blood calcium,serum creatinine,platelets,blood urea nitrogen,serum creatinine,aspartate aminotransferase,and brain natriuretic peptide(P<0.05).Multivariate logistic regression analysis showed that the risk factors for AKI of critically ill patients included age,APACHE II score,and extrarenal organ failure.number,severe infection,CKD,surgery,serum creatinine,and brain natriuretic peptide,with the probability lower than 0.001.Conclusion Old age,high APACHE II score,extrarenal organ failure,severe infection,CKD,surgery,elevated serum creatinine,and elevated brain natriuretic peptide were major risk factors for AKI of critically ill patients,and the above-mentioned abnormal indicators suggest increased risk of AKI in patients,so attention should be paid in the clinical treatment to improve the prognosis of patients.
作者
李秀元
高金霞
张增雷
吕恒娟
宋秋颖
李强
叶虹婷
Li Xiuyuan;Gao Jinxia;ZhangZenglei;LüHengjuan;Song Qiuying;Li Qiang;Ye Hongting(Hongqi Hospital,Mudanjiang Medical College,Mudanjiang157011,China;School of Public Health,Mudanjiang Medical College)
出处
《中国医院统计》
2019年第4期249-253,共5页
Chinese Journal of Hospital Statistics
基金
黑龙江省卫生计生委科研基金项目(2016-398)
黑龙江省教育厅科学技术研究项目基金项目(12541848)
牡丹江医学院科学技术研究项目(ZS201313)
关键词
危重症
急性肾损伤
巢式病例对照研究
critical illness
acute kidney injury
nested case-control study
