摘要
目的分析急性肾损伤(AKI)患儿进行肾脏替代治疗(RRT)的不良预后因素。方法采用回顾性病例对照研究方法,收集6家三甲医院2015年5月至2018年6月住院接受RRT治疗的134例(男82例、女52例)AKI患儿的临床资料。根据出院时血肌酐(SCr)恢复情况,分为预后良好组和预后不良组,比较两组原发疾病、AKI分期、开始RRT时间、尿量以及并发症等临床资料。组间比较采用t检验、Mann-Whitney U检验及χ^2检验;不良预后危险相关因素的分析采用单因素及非条件二元Logistic回归分析。结果134例患儿年龄(6±4)岁。预后良好114例(85.0%),预后不良20例(15.0%)。两组性别(χ^2=2.596,P=0.107)、年龄(t=0.718,P=0.474)、原发疾病(χ^2=2.076,P=0.722)、AKI分期(χ^2=0.004,P=0.998)、诊断AKI距开始RRT时间(h)(P=0.745)及是否24 h内开始RRT(χ^2=0.016,P=0.899)、尿量(χ^2=3.118,P=0.374)、容量超负荷(χ^2=0.014,P=0.905)、多器官功能障碍综合征(MODS)(χ^2=2.972,P=0.085)、酸中毒(χ^2=3.204,P=0.073)、高钾血症(χ^2=2.829,P=0.093)、开始RRT时血尿素氮(t=1.351,P=0.179)及SCr(P=0.901)水平差异无统计学意义。预后不良组机械通气[45%(9/20)比12.3%(14/114),χ^2=12.811,P<0.01]、肾外脏器受累数≥3个患者[30%(6/20)比10.5%(12/114),χ^2=6.365,P=0.041]比例高于预后良好组,差异有统计学意义。Logistic回归分析显示RRT治疗的AKI患儿不良预后影响因素是机械通气(OR=12.540,95%CI:3.376~46.577,P<0.01)、高钾血症(OR=4.611,95%CI:1.265~16.805,P=0.021)。结论机械通气、高钾血症为RRT治疗的AKI患儿不良预后的影响因素。
Objective To investigate the predictive factors of poor prognosis in children with acute kidney injury(AKI)treated with renal replacement therapy(RRT).Methods In this retrospective case-control study,the clinical data were collected from 134 pediatric patients(82 male,52 female)with AKI treated with RRT in six tertiary hospitals from May 2015 to June 2018.According to the serum creatinine level at discharge,the patients were divided into the favorable outcome group and unfavorable outcome group.The data of sex,age,primary diseases,AKI stage,time from diagnosis of AKI to start of RRT(h)and whether to start RRT within 24 hours,urine volume and complications between the two groups were compared.Continuous variables were compared by t test and Mann-Whitney U test,and percentage or proportions were compared by Chi square test.The predictive factors of adverse prognosis were analyzed by using univariate and unconditional binary logistic regression analysis.Results The average age of the 134 AKI patients was(6±4)years.There were 114 patients(85.0%)in the favorable outcome group and 20 patients(15.0%)in the unfavorable outcome group.No statistically significant differences were found between the two groups in terms of sex(χ^2=2.596,P=0.107),age(t=0.718,P=0.474),primary disease(χ^2=2.076,P=0.722),AKI stage(χ^2=0.004,P=0.998),time from diagnosis of AKI to start RRT(h)(P=0.745),whether to start RRT within 24 hours(χ^2=0.016,P=0.899),urine volume(χ^2=3.118,P=0.374),fluid overload(χ^2=0.014,P=0.905),multiple organ dysfunction syndrome(MODS)(χ^2=2.972,P=0.085),acidosis(χ^2=3.204,P=0.073),hyperkalemia(χ^2=2.829,P=0.093),the level of blood urea nitrogen(t=1.351,P=0.179)and serum creatinine(P=0.901)at the beginning of RRT.In the unfavorable outcome group,the proportion of patients with mechanical ventilation(45.0%(9/20)vs.12.3%(14/114),χ^2=12.811,P<0.01)and the incidence of extra organ injury(≥3)(30.0%(6/20)vs.10.5%(12/114),χ^2=6.365,P=0.041)were higher than those in the favorable outcome group.Logistic regression a
作者
徐海霞
邵晓珊
李宇红
应蓓
邱杰
郑莎莎
唐勇
冯杰
吕学云
吴琳
厉洪江
唐筠
Xu Haixia;Shao Xiaoshan;Li Yuhong;Ying Bei;Qiu Jie;Zheng Shasha;Tang Yong;Feng Jie;Lyu Xueyun;Wu Lin;Li Hongjiang;Tang Yun(Department of Nephrology and Rheumatology,Guiyang Maternal&Child Health Care Hospital,Guiyang Children′s Hospital,Guiyang 550003,China;Department of Nephrology and Rheumatology,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Department of Nephrology and Rheumatology,Liaocheng Children′s Hospital,Liaocheng 252000,China;Department of Nephrology,Anhui Provincial Children′s Hospital,Hefei 230051,China;Department of Nephrology,Henan Provincial Children′s Hospital,Zhengzhou 450018,China;Department of Nephrology and Immunology,Xi′an Children′s Hospital,Xi′an 710003,China)
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2020年第9期725-730,共6页
Chinese Journal of Pediatrics
基金
贵州省科技厅课题基金(黔科合LH[2015]7031)
福棠儿童医学发展研究中心科研课题基金。
关键词
急性肾损伤
肾脏替代治疗
预后
儿童
Acute kidney injury
Renal replacement therapy
Prognosis
Child
