早產(chǎn)兒急性腎損傷發(fā)生情況及相關(guān)危險因素分析
發(fā)布時間：2018-12-18 13:39
【摘要】：目的:調(diào)查早產(chǎn)兒急性腎損傷(AKI)的發(fā)生情況和臨床特點,分析AKI的相關(guān)危險因素。方法:本項目為回顧性研究,以2013年1月至2015年6月入住蚌埠醫(yī)學院第一附屬醫(yī)院兒科新生兒重癥監(jiān)護室的早產(chǎn)兒為研究對象,病人來源為皖北地區(qū)。早產(chǎn)兒AKI定義:不論日齡和尿量,血清肌酐值(SCr)1.5 mg/dl(133μmol/L)。檢索電子病歷系統(tǒng),病例納入標準:出生胎齡37周,入院日齡1 d。病例排除標準:資料不完整,先天性泌尿系統(tǒng)畸形,母親有腎衰竭史,生后48小時內(nèi)死亡或轉(zhuǎn)出至其他醫(yī)院的患兒。將住院過程中發(fā)生AKI的早產(chǎn)兒設(shè)定為病例組,同期住院過程中未發(fā)生AKI的早產(chǎn)兒設(shè)為對照組。收集資料如下:患兒一般情況如性別、胎齡、出生體重,妊娠史,患兒圍生期情況,發(fā)生AKI之前的基礎(chǔ)疾病,實驗室資料,以及住院時間等。采用單因素分析及二分類Logistic回歸模型進行數(shù)據(jù)分析,篩選出AKI相關(guān)危險因素。結(jié)果:共收集早產(chǎn)兒750例,平均胎齡為(34.14±1.98)周,平均出生體重(2146.91±492.20)克。AKI組263例,占總數(shù)的35.07%,非AKI組487例,占總數(shù)的64.93%;AKI組中,男性166例,占本組的63.12%,女性97例,占本組的36.88%,男女比例為1.71:1;非AKI組中,男性301例,占本組的61.81%,女性186例,占本組的38.19%,男女比例為1.62:1。單因素分析表明2組早產(chǎn)兒在出生體重、胎齡、胎盤早剝、妊娠期高血壓疾病、Apgar 1分鐘評分、Apgar5分鐘評分、生后1周內(nèi)發(fā)熱、機械通氣、輸血治療、新生兒呼吸窘迫綜合征、敗血癥、新生兒感染、代謝性酸中毒、CRP、PCT方面差異有統(tǒng)計學意義。二分類Logistic回歸分析表明妊娠期高血壓疾病(OR=1.573,95%CI 1.080~2.290),生后1周內(nèi)發(fā)熱(OR=2.049,95%CI 1.457~2.881)、新生兒呼吸窘迫綜合征(OR=1.674,95%CI 1.135~2.469)、代謝性酸中毒(OR=2.351,95%CI1.103~5.012)、輸血(OR=9.202,95%CI 4.224~20.050)、胎齡34周(OR=1.636,95%CI 1.132~2.364)與早產(chǎn)兒AKI顯著相關(guān)。結(jié)論:早產(chǎn)兒AKI發(fā)生率為35.07%。妊娠期高血壓疾病、生后1周內(nèi)發(fā)熱、新生兒呼吸窘迫綜合征、代謝性酸中毒、輸血治療、胎齡34周是早產(chǎn)兒AKI的獨立危險因素。加強妊娠期和新生兒期管理,有望降低早產(chǎn)兒AKI的發(fā)生率。
[Abstract]:Objective: to investigate the incidence and clinical characteristics of (AKI) in premature infants with acute renal injury and to analyze the risk factors of AKI. Methods: a retrospective study was conducted on premature infants admitted to the Pediatric Neonatal intensive Care Unit of the first affiliated Hospital of Bengbu Medical College from January 2013 to June 2015. AKI definition: serum creatinine (SCr) 1. 5 mg/dl (133 渭 mol/L) regardless of age and urine volume. The electronic medical record system was searched. The inclusion criteria were 37 weeks of gestational age and 1 day of admission. Exclusion criteria: incomplete data, congenital urinary system malformations, mothers with a history of renal failure, and children who died or were transferred to other hospitals within 48 hours of birth. Premature infants with AKI during hospitalization were selected as case group, and premature infants without AKI during hospitalization were set as control group. The data were as follows: sex, gestational age, birth weight, pregnancy history, perinatal period, basic diseases before AKI, laboratory data and hospital stay. Single factor analysis and two classification Logistic regression model were used to analyze the data and the risk factors related to AKI were screened out. Results: a total of 750 premature infants were collected. The average gestational age was (34.14 鹵1.98) weeks, and the average birth weight was (2146.91 鹵492.20) g. There were 263 cases in AKI group (35.07%) and 487 cases in non-AKI group (64.93%). In the AKI group, there were 166 males (63.12%) and 97 females (36.88%). The ratio of male to female was 1.71: 1; In the non-AKI group, there were 301 males (61.81%) and 186 females (38.19%). The ratio of male to female was 1.62: 1. Univariate analysis showed that the birth weight, gestational age, placental abruption, hypertensive disorder complicating pregnancy, Apgar 1 minute score, Apgar5 minute score, fever, mechanical ventilation, blood transfusion therapy, neonatal respiratory distress syndrome (RDS) were measured in the two groups. Septicemia, neonatal infection, metabolic acidosis, CRP,PCT differences were statistically significant. Two classification Logistic regression analysis showed that hypertensive disorder complicating pregnancy (OR=1.573,95%CI 1.080 鹵2.290), fever within one week (OR=2.049,95%CI 1.457 鹵2.881), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), and neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135, 2.469). Metabolic acidosis (OR=2.351,95%CI1.103~5.012), blood transfusion (OR=9.202,95%CI 4.224) and gestational age of 34 weeks (OR=1.636,95%CI 1.132 鹵2.364) were significantly associated with AKI in premature infants. Conclusion: the incidence of AKI in premature infants is 35.07. Hypertensive disorder complicating pregnancy, fever within 1 week after birth, neonatal respiratory distress syndrome, metabolic acidosis, transfusion therapy and gestational age of 34 weeks were independent risk factors for AKI of premature infants. Strengthening the management of gestation and newborn is expected to reduce the incidence of AKI in preterm infants.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R722.6
本文編號：2385929
[Abstract]:Objective: to investigate the incidence and clinical characteristics of (AKI) in premature infants with acute renal injury and to analyze the risk factors of AKI. Methods: a retrospective study was conducted on premature infants admitted to the Pediatric Neonatal intensive Care Unit of the first affiliated Hospital of Bengbu Medical College from January 2013 to June 2015. AKI definition: serum creatinine (SCr) 1. 5 mg/dl (133 渭 mol/L) regardless of age and urine volume. The electronic medical record system was searched. The inclusion criteria were 37 weeks of gestational age and 1 day of admission. Exclusion criteria: incomplete data, congenital urinary system malformations, mothers with a history of renal failure, and children who died or were transferred to other hospitals within 48 hours of birth. Premature infants with AKI during hospitalization were selected as case group, and premature infants without AKI during hospitalization were set as control group. The data were as follows: sex, gestational age, birth weight, pregnancy history, perinatal period, basic diseases before AKI, laboratory data and hospital stay. Single factor analysis and two classification Logistic regression model were used to analyze the data and the risk factors related to AKI were screened out. Results: a total of 750 premature infants were collected. The average gestational age was (34.14 鹵1.98) weeks, and the average birth weight was (2146.91 鹵492.20) g. There were 263 cases in AKI group (35.07%) and 487 cases in non-AKI group (64.93%). In the AKI group, there were 166 males (63.12%) and 97 females (36.88%). The ratio of male to female was 1.71: 1; In the non-AKI group, there were 301 males (61.81%) and 186 females (38.19%). The ratio of male to female was 1.62: 1. Univariate analysis showed that the birth weight, gestational age, placental abruption, hypertensive disorder complicating pregnancy, Apgar 1 minute score, Apgar5 minute score, fever, mechanical ventilation, blood transfusion therapy, neonatal respiratory distress syndrome (RDS) were measured in the two groups. Septicemia, neonatal infection, metabolic acidosis, CRP,PCT differences were statistically significant. Two classification Logistic regression analysis showed that hypertensive disorder complicating pregnancy (OR=1.573,95%CI 1.080 鹵2.290), fever within one week (OR=2.049,95%CI 1.457 鹵2.881), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), and neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135, 2.469). Metabolic acidosis (OR=2.351,95%CI1.103~5.012), blood transfusion (OR=9.202,95%CI 4.224) and gestational age of 34 weeks (OR=1.636,95%CI 1.132 鹵2.364) were significantly associated with AKI in premature infants. Conclusion: the incidence of AKI in premature infants is 35.07. Hypertensive disorder complicating pregnancy, fever within 1 week after birth, neonatal respiratory distress syndrome, metabolic acidosis, transfusion therapy and gestational age of 34 weeks were independent risk factors for AKI of premature infants. Strengthening the management of gestation and newborn is expected to reduce the incidence of AKI in preterm infants.
【學位授予單位】：蚌埠醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R722.6
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，本文編號：2385929
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