重癥監(jiān)護病房住院患者院內獲得性急性腎損傷的臨床研究
發(fā)布時間：2018-08-13 09:38
【摘要】：目的:急性腎損傷(acute kidney injury,AKI)是危重患者的常見并發(fā)癥之一,增加了重癥監(jiān)護病房(intensive care unit,ICU)住院患者的病死率,導致了沉重的醫(yī)療負擔。本研究收集ICU內發(fā)生院內獲得性急性腎損傷(hospital-acquired acute kidney injury,HA-AKI)并發(fā)癥患者的臨床資料,分析其臨床特點及預后情況。了解本地區(qū)綜合性三級醫(yī)院ICU住院患者HA-AKI的發(fā)病率、病因構成、治療措施及預后情況,初步探討ICU住院患者并發(fā)HA-AKI的危險因素及影響預后的危險因素,為臨床積極預防急性腎損傷的發(fā)生、早期診斷并采取有效的治療措施提供依據(jù)。方法:采用回顧性分析的方法,收集醫(yī)院2014年1月1日至2015年12月31日兩年中入住ICU的1317例患者的臨床資料,根據(jù)2012-年改善全球腎病預后組織(Kidney Disease:Improving Global Outcomes,KDIGO)制定的AKI診斷及分期標準篩選出符合納入標準的病例,記錄其一般情況、既往史、臨床特征及患者在入院/ICU時、出現(xiàn)HA-AKI時和出院/死亡前的相關實驗室檢測指標、預后情況(以出院或院內死亡為研究終點記錄患者的臨床轉歸)。根據(jù)患者預后將納入的病例分為死亡組、腎功能部分恢復組及完全恢復組,對HA-AKI發(fā)生前后、完全恢復組及死亡組的各項參數(shù)進行比較。正態(tài)分布的計量資料使用均數(shù)±標準差(?X±S)表示,采用兩獨立樣本t檢驗;非正態(tài)分布的計量資料使用Median(P25,P75)表示,采用兩獨立樣本秩和檢驗;計數(shù)資料以絕對值或構成比表示,兩組間比較采用χ2檢驗,兩因素的相關性分析采用線性相關分析,多因素采用Logistic回歸分析方法。使用SPSS17.0統(tǒng)計軟件對所有數(shù)據(jù)進行分析。結果:1.兩年中共有1317例患者入住ICU,HA-AKI患者共188例,發(fā)病率為14.27%;其中AKI 1期組103例(54.79%),AKI 2期組35例(18.61%),AKI 3期組50例(26.60%);AKI分期越高,患者感染性休克發(fā)生率、器官衰竭數(shù)、機械通氣使用率、血管活性藥物使用率、急性生理學與慢性健康狀況評分系統(tǒng)Ⅱ(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)評分越高(P0.05)。2.HA-AKI原發(fā)病前三位分別是:感染(n=70,37.2%),外傷性疾病(n=62,32.9%),腦血管意外(n=23,12.2%);按病變部位分析病因:其中腎前性86例(45.7%),主要原因為外傷出血,其次為心力衰竭。腎性95例(50.6%),膿毒癥為首要病因(53例,55.8%);腎后性7例(3.7%),主要病因為泌尿系統(tǒng)結石、腹盆腔腫瘤等。按年齡分析病因:中青年組(年齡60歲)77例,以腎性病因為主,占71.7%,年齡60歲的老年組有111例,以腎前性病因為主,占58.6%;通過組間比較顯示老年組以腎前性及腎后性病因為主,中青年組以腎性病因為主,差異有統(tǒng)計學意義(P0.05)。3.188例HA-AKI死亡患者87例,病死率46.28%,其中AKI 1期組36例(34.9%),AKI 2期組18例(51.4%),AKI 3期組33例(66.0%)。AKI分期越高,病死率越高。按年齡分析:中青年組死亡率(n=24,31.2%)顯著低于老年組死亡率(n=63,56.8%)(P0.01)。4.HA-AKI患者死亡風險增加的因素有:年齡(≥60歲)(χ2=3.4571,P0.05)、膿毒癥性休克(χ2=21.3214,P0.01)、器官衰竭數(shù)目2(χ2=17.5710,P0.01)、機械通氣(χ2=23.6574,P0.01)、低血壓(χ2=30.5709,P0.01)、APACHEⅡ評分(20分)(χ2=14.6431,P0.01)。5.ICU患者并發(fā)HA-AKI的獨立危險因素:機械通氣、膿毒癥性休克。結論:ICU住院患者并發(fā)HA-AKI的發(fā)病率及病死率均較高。AKI分期越高,患者年齡越大,病死率越高。HA-AKI的原發(fā)病前三位依次是:感染、嚴重外傷、腦血管意外。年齡(60歲)、膿毒癥休克、APACHEⅡ評分(20分)、機械通氣、低血壓史、腎外器官衰竭數(shù)2是與HA-AKI預后相關的危險因素。機械通氣、膿毒癥性休克是HA-AKI發(fā)生的獨立危險因素。
[Abstract]:Objective: Acute kidney injury (AKI) is one of the common complications in critically ill patients, which increases the fatality rate of inpatients in intensive care unit (ICU) and leads to heavy medical burden. To investigate the incidence, etiology, treatment and prognosis of HA-AKI in ICU inpatients of general tertiary hospitals in this region, and to explore the risk factors and prognostic factors of HA-AKI in ICU inpatients, so as to prevent acute kidney injury. Methods: The clinical data of 1317 patients admitted to ICU from January 1, 2014 to December 31, 2015 were retrospectively analyzed. The data were based on the Kidney Disease: Improving Global Outcomes (KDIGO) system from 2012 to December 31, 2015. AKI diagnostic criteria and staging criteria were used to screen patients who met the inclusion criteria and record their general condition, past history, clinical characteristics, laboratory test indicators at the time of HA-AKI onset and before discharge/death, and prognosis (with discharged or in-hospital deaths as the end point of study to record clinical outcomes). The patients were divided into death group, partial recovery group and complete recovery group. The parameters of HA-AKI before and after the occurrence of HA-AKI were compared with those of the death group. 5) Two independent sample rank sum test was used; the counting data were expressed by absolute value or composition ratio. _2 test was used for comparison between the two groups. Linear correlation analysis was used for correlation analysis of the two factors, and logistic regression analysis was used for multiple factors. A total of 188 patients (14.27%) with HA-AKI were admitted to ICU, including 103 patients (54.79%) in AKI stage 1 group, 35 patients (18.61%) in AKI stage 2 group and 50 patients (26.60%) in AKI stage 3 group. The first three primary diseases of HA-AKI were infection (n=70,37.2%), traumatic disease (n=62,32.9%) and cerebrovascular accident (n=23,12.2%). Ninety-five cases (50.6%) were renal, 53 cases (55.8%) were sepsis, 7 cases (3.7%) were postrenal, the main causes were urinary calculi, abdominal and pelvic tumors, etc. The comparison showed that pre-renal and post-renal causes were predominant in the elderly group, and renal causes were predominant in the young and middle-aged group. The difference was statistically significant (P 0.05). 3.188 patients died of HA-AKI, with a fatality rate of 46.28%. Among them, 36 (34.9%) were in the AKI stage 1 group, 18 (51.4%) in the AKI stage 2 group, and 33 (66.0%) in the AKI stage 3 group. The mortality rate in young and middle-aged group (n = 24,31.2%) was significantly lower than that in elderly group (n = 24,31.2%) (n = 63,56.8%) (P 0.01). 4. The risk factors for increased mortality in HA-AKI patients were age (>60 years) (962 = 3.4571, P 0.05), septicshock (962 = 21.3214, P 0.01), septicshock (962 = 21.3214, P 0.01), number of organfailure (962 = 17.5710, P 0.01), mechanical ventiventiventiventiventi (962 = 23.74, P 0.01), hypotblood pressure (962 = 23.74, P 0.01), hypotblood pressure (962 = 30.30.01, P 0 In the meantime, it is necessary to study the relationship between the two. The independent risk factors of HA-AKI in ICU patients were mechanical ventilation and septic shock. Conclusion: The morbidity and mortality of HA-AKI in ICU inpatients were higher. The higher the AKI stage, the older the patients, the higher the mortality. The first three HA-AKI cases were infection, severe trauma, septic shock. Age (60 years), septic shock, APACHE II score (20 points), mechanical ventilation, history of hypotension, and number of extrarenal organ failure 2 were risk factors associated with the prognosis of HA-AKI. Mechanical ventilation and septic shock were independent risk factors for HA-AKI.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5
本文編號：2180594
[Abstract]:Objective: Acute kidney injury (AKI) is one of the common complications in critically ill patients, which increases the fatality rate of inpatients in intensive care unit (ICU) and leads to heavy medical burden. To investigate the incidence, etiology, treatment and prognosis of HA-AKI in ICU inpatients of general tertiary hospitals in this region, and to explore the risk factors and prognostic factors of HA-AKI in ICU inpatients, so as to prevent acute kidney injury. Methods: The clinical data of 1317 patients admitted to ICU from January 1, 2014 to December 31, 2015 were retrospectively analyzed. The data were based on the Kidney Disease: Improving Global Outcomes (KDIGO) system from 2012 to December 31, 2015. AKI diagnostic criteria and staging criteria were used to screen patients who met the inclusion criteria and record their general condition, past history, clinical characteristics, laboratory test indicators at the time of HA-AKI onset and before discharge/death, and prognosis (with discharged or in-hospital deaths as the end point of study to record clinical outcomes). The patients were divided into death group, partial recovery group and complete recovery group. The parameters of HA-AKI before and after the occurrence of HA-AKI were compared with those of the death group. 5) Two independent sample rank sum test was used; the counting data were expressed by absolute value or composition ratio. _2 test was used for comparison between the two groups. Linear correlation analysis was used for correlation analysis of the two factors, and logistic regression analysis was used for multiple factors. A total of 188 patients (14.27%) with HA-AKI were admitted to ICU, including 103 patients (54.79%) in AKI stage 1 group, 35 patients (18.61%) in AKI stage 2 group and 50 patients (26.60%) in AKI stage 3 group. The first three primary diseases of HA-AKI were infection (n=70,37.2%), traumatic disease (n=62,32.9%) and cerebrovascular accident (n=23,12.2%). Ninety-five cases (50.6%) were renal, 53 cases (55.8%) were sepsis, 7 cases (3.7%) were postrenal, the main causes were urinary calculi, abdominal and pelvic tumors, etc. The comparison showed that pre-renal and post-renal causes were predominant in the elderly group, and renal causes were predominant in the young and middle-aged group. The difference was statistically significant (P 0.05). 3.188 patients died of HA-AKI, with a fatality rate of 46.28%. Among them, 36 (34.9%) were in the AKI stage 1 group, 18 (51.4%) in the AKI stage 2 group, and 33 (66.0%) in the AKI stage 3 group. The mortality rate in young and middle-aged group (n = 24,31.2%) was significantly lower than that in elderly group (n = 24,31.2%) (n = 63,56.8%) (P 0.01). 4. The risk factors for increased mortality in HA-AKI patients were age (>60 years) (962 = 3.4571, P 0.05), septicshock (962 = 21.3214, P 0.01), septicshock (962 = 21.3214, P 0.01), number of organfailure (962 = 17.5710, P 0.01), mechanical ventiventiventiventiventi (962 = 23.74, P 0.01), hypotblood pressure (962 = 23.74, P 0.01), hypotblood pressure (962 = 30.30.01, P 0 In the meantime, it is necessary to study the relationship between the two. The independent risk factors of HA-AKI in ICU patients were mechanical ventilation and septic shock. Conclusion: The morbidity and mortality of HA-AKI in ICU inpatients were higher. The higher the AKI stage, the older the patients, the higher the mortality. The first three HA-AKI cases were infection, severe trauma, septic shock. Age (60 years), septic shock, APACHE II score (20 points), mechanical ventilation, history of hypotension, and number of extrarenal organ failure 2 were risk factors associated with the prognosis of HA-AKI. Mechanical ventilation and septic shock were independent risk factors for HA-AKI.
【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5
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