發(fā)布時(shí)間：2018-05-02 00:05

  本文選題：社區(qū)獲得性肺炎 + 急性腎損傷�。� 參考：《天津醫(yī)藥》2014年10期

【摘要】：目的探討社區(qū)獲得性肺炎(CAP)患者伴發(fā)急性腎損傷(AKI)的預(yù)后危險(xiǎn)因素。方法 456例CAP患者為無(wú)伴發(fā)AKI(N-AKI)組和伴發(fā)AKI組。AKI組又根據(jù)RIFLE的嚴(yán)重程度級(jí)別分為3個(gè)亞組:危險(xiǎn)(Risk)、損傷(Injury)和衰竭(Failure)組。比較各組患者CAP的嚴(yán)重程度,各項(xiàng)臨床指標(biāo)和預(yù)后評(píng)估指標(biāo)的差別;多因素分析采用Logistic回歸模型,生存分析采用Kaplan-Meier法,分析影響CAP患者預(yù)后不良的危險(xiǎn)因素及RIFLE標(biāo)準(zhǔn)在預(yù)后評(píng)估中作用。結(jié)果 456例CAP患者中有30%(135例)伴發(fā)AKI,診斷為Risk 61例(45.2%),Injury 23例(17%),Failure 51例(37.8%)。CAP患者PSI評(píng)分為Ⅰ~Ⅲ級(jí)的患者(300例)中有23.3%(70例)伴發(fā)AKI,PSI分級(jí)≥IV的患者(156例)中有41.7%(65例)伴發(fā)AKI,差異有統(tǒng)計(jì)學(xué)意義(P0.01)。伴發(fā)AKI的CAP患者30 d病死率隨AKI嚴(yán)重程度增加(N-AKI患者6.2%,Risk患者14.8%,Injury患者21.7%,Failure患者45.1%)。此外,隨著AKI嚴(yán)重程度增加,需要機(jī)械通氣、正性肌力藥物和腎臟替代治療的患者比例增加。Logistic回歸分析顯示合并AKI、75歲、合并腎外器官衰竭是住院CAP患者預(yù)后不良的危險(xiǎn)因素。結(jié)論住院CAP患者伴發(fā)AKI的預(yù)后不良。RIFLE診斷及分級(jí)標(biāo)準(zhǔn)可有效評(píng)估CAP伴發(fā)AKI患者的預(yù)后。
[Abstract]:Objective to investigate the prognostic risk factors of acute renal injury (AKI) in patients with community-acquired pneumonia (CAP). Methods 456 patients with CAP were divided into three subgroups according to the severity of RIFLE: the group without AKIN-AKI and the group with AKI. The severity of CAP, clinical indexes and prognostic evaluation indexes were compared among the three groups. Logistic regression model was used for multivariate analysis and Kaplan-Meier method was used for survival analysis. To analyze the risk factors of poor prognosis in patients with CAP and the role of RIFLE criteria in prognosis evaluation. Results of the 456 patients with CAP, 30135 were associated with AKI, and 61 patients with Risk were diagnosed as having 45.2fibronectomies. Twenty-three of the 51patients with PSI grade 鈪，

本文編號(hào)：1831570