摘要
目的评估万古霉素联合β-内酰胺类抗菌药物治疗重症患者致急性肾损伤(AKI)的相关危险因素。方法选择2020年1月—2022年1月本院收治的应用万古霉素联合β-内酰胺类抗菌药物治疗的重症患者100例开展回顾性研究,根据治疗期间是否并发AKI将其分为AKI组(31例)与非AKI组(69例)两组。记录所有重症患者性别、年龄等基线资料,并采用多元Logistic回归分析探讨万古霉素联合β-内酰胺类抗菌药物治疗重症患者致AKI的相关危险因素。结果AKI组重症患者ICU住院时间(17.53±2.29)d明显多于非AKI组,万古霉素日剂量(2.38±0.42)g/d、万古霉素谷浓度(22.91±2.75)μg/ml以及APACHE-Ⅱ评分(24.85±3.14)分均明显大于非AKI组,而合并低蛋白血症54.84%(17/31)、合并高尿酸血症48.39%(15/31)、合并感染性休克67.74%(21/31)、联用哌拉西林他唑巴坦51.61%(16/31)以及合并袢利尿剂用药45.16%(14/31)百分比均明显高于非AKI组(均P<0.05);而两组重症患者其余基线资料之间均差异无统计学意义(P>0.05)。多元Logistic回归分析表明万古霉素日剂量(OR=1.582,95%CI:1.136-2.503)、万古霉素谷浓度(OR=2.417,95%CI:1.691-3.613)、低蛋白血症(OR=1.628,95%CI:1.075-2.239)、高尿酸血症(OR=2.157,95%CI:1.422-3.951)、感染性休克(OR=1.849,95%CI:1.283-2.608)、哌拉西林他唑巴坦(OR=1.798,95%CI:1.245-2.272)、袢利尿剂(OR=1.916,95%CI:1.539-4.101)以及APACHE-Ⅱ评分(OR=1.487,95%CI:1.143-2.597)均为万古霉素联合β-内酰胺类抗菌药物治疗重症患者致AKI发生的独立危险因素(均P<0.05)。结论万古霉素联合β-内酰胺类抗菌药物治疗重症患者AKI的发生与万古霉素日剂量与谷浓度、低蛋白血症、高尿酸血症、感染性休克、哌拉西林他唑巴坦、袢利尿剂以及APACHE-Ⅱ评分关系密切,通过对其进行干预有助于防范AKI的发生。
Objective To explore the risk factors associated with acute kidney injury(AKI)in severe patients treated with vancomycin combinationβ-lactam antibacterials.Methods 100 severe patients treated with vancomycin combined withβ-lactam antibacterials in our hospital from Jan 2020 to Jan 2022 were selected for retrospective study.They were divided into the AKI group(31 cases)and the non AKI group(69 cases)according to the presence and absence of AKI during treatment.The baseline data of all severe patients such as sex and age were recorded.The multiple logistic regression analysis was used to explore the risk factors associated with AKI in severe patients induced by treatment of vancomycin combined withβ-lactam antibacterials.Results The ICU hospitalization time of the severe patients in AKI group(17.53±2.29)d was significantly longer than the non AKI group.The daily dose of vancomycin(2.38±0.42)g/d,the valley concentration of vancomycin(22.91±2.75)μg/ml and the APACHE-II score(24.85±3.14)were significantly higher than the non AKI group.The percentages of hypoalbuminemia 54.84%(17/31),hyperuricemia 48.39%(15/31),infectious shock 67.74%(21/31),combined use of piperacillin tazobactam 51.61%(16/31)and combined use of loop diuretic 45.16%(14/31)in the AKI group were significantly higher than the non AKI group(P<0.05).There was no significant difference in other baseline data between the two groups severe patients(P>0.05).The multiple logistic regression analysis showed that the daily dose of vancomycin(OR=1.582,95%CI:1.136-2.503),the valley concentration of vancomycin(OR=2.417,95%CI:1.691-3.613),hypoalbuminemia(OR=1.628,95%CI:1.075-2.239),hyperuricemia(OR=2.157,95%CI:1.422-3.951),infectious shock(OR=1.849,95%CI:1.283-2.608),piperacillin tazobactam(OR=1.798,95%CI:1.245-2.272),loop diuretics(OR=1.916,95%CI:1.539-4.101)and APACHE-II score(OR=1.487,95%CI:1.143-2.597)were independent risk factors associated with AKI in severe patients treated with vancomycin combinationβ-lactam antibacterials(all P<0.05).Conclusions The
作者
康琰晨
刘涛
Kang Yanchen;Liu Tao(School of Medicine,Yan'an University,Yan'an,719300,China)
出处
《齐齐哈尔医学院学报》
2023年第8期732-736,共5页
Journal of Qiqihar Medical University
