本文關(guān)鍵詞： 重癥監(jiān)護(hù)室 急性腎損傷 AKIN診斷標(biāo)準(zhǔn) 危險(xiǎn)因素 預(yù)后　出處：《福建醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：比較重癥監(jiān)護(hù)室(ICU)與非ICU的AKI患者臨床特征及其預(yù)后相關(guān)危險(xiǎn)因素。 方法：回顧性分析福建醫(yī)科大學(xué)附屬第一醫(yī)院2011年期間符合AKIN診斷標(biāo)準(zhǔn)的703例住院的AKI患者的臨床資料，按是否進(jìn)入重癥監(jiān)護(hù)室分為ICU組與非ICU組，對(duì)比其臨床特征，并用多因素Logistic回歸分析其預(yù)后危險(xiǎn)因素。 結(jié)果： 1、703例AKI患者，非ICU組486例，ICU組217例。與非ICU組比較，ICU組患者AKI分期更差：1期(35.0%vs57.8%，P0.001)，2期(21.2%vs15.8%，，P=0.084)，3期(43.8%vs26.4%，P0.001)，腎功能丟失率更高(56.7%vs21.5%，P0.001)，病死率也更高(53.9%vs10.7%，P0.001)。 2、ICU組與非ICU組引起AKI的病因均以腎前性為主(73.3%vs60.0%，P0.001)，ICU組的腎臟替代治療率(25.8%vs7.4%，P0.001)、機(jī)械通氣使用率(71.9%vs2.9%，P0.001)、升壓藥的使用率(61.8%vs11.1%，P0.001)均明顯高于非ICU組。 3、ICU組引起腎功能丟失的危險(xiǎn)因素有APACHII評(píng)分(P0.001，OR值=1.181)、機(jī)械通氣(P=0.001，OR值=4.187)、少尿史(P=0.015，OR值=2.981)、低血壓史(P=0.001，OR值=3.422)、凝血異常(P=0.021，OR值=3.455)；而非ICU組為AKI分期(P0.001，OR值=3.187)、高血壓病(P=0.035，OR值=1.984)、惡性腫瘤史(P=0.001，OR值=3.225)、慢性腎臟病(P=0.018，OR值=2.131)、利尿劑(P=0.004，OR值=2.437)、低血壓(P0.001，OR值=10.152)、腎外器官衰竭數(shù)(P=0.001，OR值=2.055)。 4、ICU組引起患者死亡的危險(xiǎn)因素有APACHII評(píng)分(P0.001，OR值=1.289)、機(jī)械通氣(P=0.006，OR值=4.241)、低血壓史(P0.001，OR值=17.308)、膿毒癥(P=0.027，OR值=4.050)；而非ICU組為惡性腫瘤(P=0.005，OR值=3.513)、低血壓史(P0.001，OR值=34.724)、RRT治療(P=0.038，OR值=3.058)、利尿劑(P=0.011，OR值=3.673)、腎外器官衰竭數(shù)(P0.001，OR值=2.737)。 結(jié)論： 1、ICU的AKI病人有更高的腎功能丟失率及病死率，其腎臟替代治療、機(jī)械通氣及升壓藥的使用率均明顯增高。 2、低血壓是ICU及非ICU的AKI病人的腎臟丟失和死亡的共同危險(xiǎn)因素。 3、APACH II評(píng)分和機(jī)械通氣是ICU的AKI病人腎臟丟失和死亡的獨(dú)立危險(xiǎn)因素，而合并基礎(chǔ)疾病、腎外器官衰竭及利尿劑的使用則是ICU的AKI病人腎臟丟失和死亡的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to compare the clinical features and prognostic risk factors between ICU and non-ICU patients with AKI. Methods: the clinical data of 703 AKI patients who met the diagnostic criteria of AKIN in the first affiliated Hospital of Fujian Medical University in 2011 were analyzed retrospectively. The patients were divided into ICU group and non ICU group according to whether they entered intensive care unit. The clinical characteristics were compared and the prognostic risk factors were analyzed by multivariate Logistic regression analysis. Results: 1,703 cases of AKI and 1,703 cases of non-#en1# group were compared with non-#en2# group. In the ICU group, the AKI stage was worse than that in the first stage (35.0 vs 57.8), and the P0.001 stage was 21.2Vs15.8VS 0.084). In phase 3, Vs26.4 and P0.001, the loss rate of renal function was higher than that of 56.7 vs21.5P0.001). The mortality rate was also higher than 53.9% vs 10.7% P 0.001. 2the etiology of AKI in ICU group and non ICU group was mainly prerenal (73.3% vs 60.0% P 0.001). The rate of renal replacement therapy in ICU group was 25. 8% vs 7. 4%, and the rate of mechanical ventilation was 71.9 vs 2. 9% P0.001). The utilization rate of blood pressure booster drug was significantly higher than that of non-ICU group (61.8 vs 11. 1 and P 0. 001). 3The risk factors of renal function loss in ICU group were APACHII score (P 0.001) OR value (1.181) and mechanical ventilation (P < 0.001). The OR value was 4.187m, the OR value of oliguria was 2.981, and the OR value of hypotension was 3.422). The OR value of P0. 021 was 3.455g; In the non-#en0# group, AKI stage (P 0.001) OR value was 3.1871, hypertension patient (P < 0.035) OR value was 1.984g, malignant tumor history was P0. 001. The OR value was 3.225, the OR value of chronic kidney disease was 2.131, the OR value of diuretic P0. 004 was 2.437g, the hypotension was P0.001. The OR value was 10.152%, and the OR value was 2.055% (P < 0.001). 4 the risk factors of death in ICU group were APACHII score (P 0.001) OR value (1.289), mechanical ventilation (P < 0.006). The OR value was 4.241, P 0.001 or was 17.308, and the OR value of sepsis was 4.050. In the non-#en0# group, the OR value of malignant tumor was 3.513, and the OR value of P 0.001 or was 34.724% in the patients with hypotension (P = 0.038, P = 0.038, P = 0.038, P = 0. 038, P = 0. 038, P = 0. 038). The OR value was 3.058, the OR value of diuretic was 0.011 and the OR value was 3.673, and the OR value of P0.001 was 2.737. Conclusion: 1in AKI patients, the rate of renal function loss and mortality was higher, and the utilization rate of renal replacement therapy, mechanical ventilation and blood pressure booster were significantly increased. 2. Hypotension is a common risk factor for kidney loss and death in ICU and non-ICU AKI patients. 3APACH II score and mechanical ventilation were independent risk factors for kidney loss and death in AKI patients with ICU, and were associated with underlying diseases. Extrarenal organ failure and diuretic use were independent risk factors for kidney loss and death in AKI patients with ICU.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R459.7

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