高齡老年人急性腎損傷危險因素及短期預(yù)后的研究
發(fā)布時間：2019-07-09 16:32
【摘要】：第一部分 老年急性腎損傷短期預(yù)后及危險因素的分析 目的對老年急性腎損傷(AKI)患者進行隨訪觀察，分析AKI的短期預(yù)后及危險因素。 方法選擇2008年1月-2009年12月就診于解放軍總醫(yī)院老年病房的232例AKI患者為研究對象，根據(jù)發(fā)生AKI后至28d時段和29d至3個月時段患者的生存情況，將患者病歷資料分成死亡組和存活組進行分析，采用t檢驗或Pearson X2檢驗篩查出影響預(yù)后的因素，將有統(tǒng)計學(xué)意義的因素為自變量進行多因素Logistic回歸分析，判斷各因素對死亡風(fēng)險的影響。 結(jié)果232例老年AKI患者，其中男性215例，女性17例，平均年齡(86.7±5.3)歲。28d內(nèi)死亡38例(16.4%)，29d至3個月內(nèi)死亡19例(9.8%)。感染(43.1%)為AKI最常見病因，其它原因依次為低血容量(19%)、腎毒性藥物(16.8%)和心血管事件(15.1%）等。多因素Logistic回歸分析顯示低體質(zhì)量指數(shù)(BMI）、少尿、機械通氣、血清白蛋白(Alb)降低、血清肌酐(Scr)峰值(246.5μmol/L)是影響老年AKI患者28d時預(yù)后的因素(均P0.05)；低BMI、Alb降低及血尿素氮(BUN)增高是影響老年AKI患者29d至3個月時預(yù)后的因素(均P0.05)。 結(jié)論感染、低血容量、腎毒性藥物、心血管事件等是誘發(fā)老年AKI最常見的原因；低BMI、少尿、機械通氣、Alb降低、BUN增高、Scr峰值(246.5μmol/L)是影響老年AKI患者預(yù)后的危險因素。 第二部分 高齡患者機械通氣后并發(fā)急性腎損傷危險因素的分析 目的對行機械通氣的老年患者進行隨訪觀察，分析高齡患者機械通氣后急性腎損傷(AKI)的發(fā)生率、相關(guān)病因及危險因素。方法選擇2008年1月~2012年12月就診于解放軍總醫(yī)院老年病房的260例機械通氣患者為研究對象，根據(jù)機械通氣后是否發(fā)生AKI分為AKI組和非AKI組進行分析。采用單因素分析初步篩查出影響預(yù)后的因素，將有統(tǒng)計學(xué)意義的因素為自變量進行Logistic回歸分析，判斷各因素對AKI的影響。 結(jié)果260例機械通氣患者，平均年齡(88.9±5)歲；機械通氣后共有125例(48.1%)患者發(fā)生AKI。機械通氣后發(fā)生AKI的平均時間(1.6±0.7)天。兩組患者相比，年齡、體質(zhì)量指數(shù)(BMI)的差異無統(tǒng)計學(xué)意義。患者伴有冠心病、慢性阻塞性肺疾病、高血壓比例在AKI組稍高于非AKI組，但差異無統(tǒng)計學(xué)意義。伴有慢性腎臟病(CKD)、糖尿病病史者，AKI組明顯高于非AKI組(66.4%比51.1%，51.2%比38.5%)，差異具有統(tǒng)計學(xué)意義(P=0.012，P=0.040);與非AKI組相比，AKI組PaO2降低(59.7±12.8比63.6±14.1，P=0.021)和氧合指數(shù)(PaO2/FiO2)降低者(122.5±42.0比145.7±46.0，P=0.000)明顯增多，血紅蛋白(105±23比100±17，P=0.046)、血糖水平(10.2±4.1比8.8±3.7，P=0.004)稍有增高，差異具有統(tǒng)計學(xué)意義；當(dāng)呼氣末正壓（PEEP）設(shè)定值≥4cmH2O時，AKI發(fā)生率更高(21.6%比10.4%)，，差異具有統(tǒng)計學(xué)意義(P=0.013)；多因素Logistic回歸分析顯示CKD(OR=1.964)、高血糖(OR=1.076)、低PaO2/FiO2(OR=2.142)和高PEEP值(≥4cmH2O, OR=0.990)是影響高齡患者接受機械通氣后發(fā)生AKI的主要危險因素(均P0.05)。 結(jié)論高齡患者機械通氣后AKI的發(fā)生率為48.1%；CKD、高血糖、低PaO2/FiO2和治療中使用高PEEP值(≥4cmH2O)是高齡患者接受機械通氣后發(fā)生AKI的獨立危險因素。 第三部分 高齡患者機械通氣后短期預(yù)后及危險因素的分析 目的對行機械通氣的老年患者進行隨訪觀察，分析機械通氣的短期預(yù)后及危險因素。 方法選擇2008年1月~2013年6月就診于解放軍總醫(yī)院老年病房的270例機械通氣患者為研究對象，根據(jù)機械通氣后至28d時段和29d至3個月時段患者的生存情況，將患者資料分成死亡組和存活組進行分析，采用單因素分析篩查出影響預(yù)后的因素，以有統(tǒng)計學(xué)意義的因素作為自變量進行多因素Logistic回歸分析，判斷各因素對死亡風(fēng)險的影響。 結(jié)果270例老年機械通氣患者，平均年齡(89.0±4.8)歲。肺部感染(70.7%)是行機械通氣最常見病因，其它原因依次為急性左心衰(10.7%)和慢性阻塞性肺疾病急性加重(AECOPD,7.8%)等。28d內(nèi)死亡86例(31.9%)，29d至3個月內(nèi)死亡40例(21.7%)。多因素logistic回歸分析顯示低氧合指數(shù)(PaO2/FiO2)、前白蛋白(Pre-Alb)降低、血尿素氮(BUN)增高、血清肌酐(Scr)增高(165.2μmol/L)、使用呼吸末正壓(PEEP)是影響老年機械通氣患者28d預(yù)后的危險因素(均P0.05)；慢性腎臟病(CKD)、C-反應(yīng)蛋白(CRP)是影響老年機械通氣患者29d至3個月時預(yù)后的危險因素(均P0.05)。 結(jié)論肺部感染、急性左心衰、AECOPD等是高齡患者機械通氣最常見的原因；CKD、低PaO2/FiO2、Pre-Alb降低、CRP、BUN增高、Scr增高(165.2μmol/L)及使用PEEP是影響高齡機械通氣患者預(yù)后的主要危險因素。
文內(nèi)圖片：
圖片說明：AKI發(fā)生后28d內(nèi)、29d至3個月內(nèi)死亡患者死亡原因(例)
[Abstract]:the first part Short-term prognosis and risk factors of acute renal injury in the aged Objective To observe the short-term prognosis and risk of AKI in elderly patients with acute renal injury (AKI). Methods:232 patients with AKI from January 2008 to December 2009 in the old ward of the General Hospital of the PLA were selected as the subjects, and the patient's medical records were divided into the death group and the surviving group according to the survival condition of the patients after the period of AKI to 28d and the period from 29d to 3 months. The group was analyzed, and the factors influencing the prognosis were screened by t-test or Pearson X2 test. The multivariate logistic regression analysis of the independent variables was performed to judge the death of each factor. The impact of the risk was found in 232 elderly patients with AKI, including 215 males,17 females, mean age (86.7% 5.3) years,38 cases (16.4%) in 28 days, and 19 deaths in 29 d to 3 months. (9.8%). The infection (43.1%) was the most common cause of AKI, and the other causes were hypovolemia (19%), nephrotoxicity (16.8%), and cardiovascular events (8%). The multivariate logistic regression analysis showed that the low body mass index (BMI), oliguria, mechanical ventilation, serum albumin (Alb) decreased, and the peak value of serum myoglobin (Scr) (246.5. mu.mol/ L) was the factor that affected the prognosis of the elderly patients with AKI (all P0.05). 5) The decrease of low BMI, Alb and the increase of blood urea nitrogen (BUN) are the factors that affect the prognosis of patients with AKI in the aged from 29d to 3 months. Conclusion Infection, low blood volume, nephrotoxic drugs and cardiovascular events are the most common causes of AKI in the elderly. Low BMI, oliguria, mechanical ventilation, Alb decrease, BUN increase, and Scr peak (246.5. mu.mol/ L) are the most common causes of AKI in the elderly. Patient's prognosis Risk factors. After mechanical ventilation in the second part of the patient The purpose of the analysis of the risk factors of acute renal injury was to follow up the elderly patients with mechanical ventilation and to analyze the acute renal injury (AKI) after mechanical ventilation in the elderly. Methods:260 cases of mechanical ventilation in the old ward of the General Hospital of the PLA from January 2008 to December 2012 were selected as the study subjects, and the AKI score after mechanical ventilation was determined. The analysis of AKI group and non-AKI group was carried out. The factors influencing the prognosis were first screened by single factor analysis, and the statistical significance of the factors was Logistic regression with the independent variables. The effect of each factor on AKI was determined, and the average age of 260 patients with mechanical ventilation was 88.9 (5) years; after mechanical ventilation, a total of 1 25 (48.1%) of the patients had AKI. After mechanical ventilation, A The average time of KI (1.6 to 0.7) days. The age, body mass, The difference of the mass index (BMI) was not statistically significant. The patient was associated with coronary heart disease, chronic obstructive pulmonary disease, and the proportion of hypertension was a little in the AKI group. The difference was statistically significant (P = 0.012, P = 0.040) in the AKI group compared with the non-AKI group (P = 0.012, P = 0.040). .7 (12.8, 63.6, 14.1, P = 0.021) and Oxygenation Index (PaO2/ FiO2) (122.5, 42.0, 145.7, 46.0, P = 0.000), hemoglobin (105,23,100,17, P = 0.046), blood glucose level (10.2, 4.1, 8.8, 3.7, P = 0.0) The incidence of AKI was higher (21.6% vs 10.4%) and the difference was statistically significant (P = 0.013). The multivariate logistic regression analysis showed that CKD (OR = 1.964), hyperglycemia (OR = 1.076), low PaO2/ FiO2 (OR = 2.14) 2) and the high PEEP (1994cmH2O, OR = 0.990) is the occurrence of A in the elderly patients after mechanical ventilation The main risk factors of KI (P0.05). Conclusion The incidence of AKI was 48.1% after mechanical ventilation in the aged patients, and the high PEEP was used in the treatment of CKD, hyperglycemia, low PaO2/ FiO2 and the treatment. receiving machine Independent risk factors for AKI after ventilation. Part 3 The purpose of the analysis of short-term prognosis and risk factors for the elderly patients with mechanical ventilation for elderly patients with mechanical ventilation The short-term prognosis and risk factors of mechanical ventilation were analyzed by follow-up observation, and 270 mechanical ventilation patients from January 2008 to June 2013 in the old ward of the General Hospital of the Liberation Army were selected as the study subjects, and according to the period of 28d after mechanical ventilation and from 29d to 3 months, The survival of the patients was analyzed, the data of the patient was divided into the death group and the survival group, and the factors influencing the prognosis were screened by single factor analysis. Logistic regression analysis to determine the effect of each factor on the risk of death. The average age of 270 elderly patients with mechanical ventilation (89.0-4.8) was the most common cause of mechanical ventilation. The other causes were acute left heart failure (10.7%) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 7.8%). 40 patients (21.7%) died within 29 d to 3 months (31.9%). The multivariate logistic regression analysis showed that the hypoxia-combined index (PaO2/ FiO2), prealbumin (Pre-Alb) decreased, blood urea nitrogen (BUN) increased, serum myoglobin (Scr) increased (165.2. mu.mol/ L), and positive positive pressure (PEEP) was used. The risk factors that affect the prognosis of the patients with mechanical ventilation in the aged (all P0.05), chronic kidney disease (CKD) and C-reactive protein (CRP) are the factors that affect the old age. Lung infection, acute left heart failure, AECOPD, etc. were the most common cause of mechanical ventilation in the elderly, and CKD, low PaO 2/ FiO2, Pre-Alb decreased, CRP, BUN increased, and Scr increased (165.2. mu.mo)
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692
本文編號：2512279
文內(nèi)圖片：
圖片說明：AKI發(fā)生后28d內(nèi)、29d至3個月內(nèi)死亡患者死亡原因(例)
[Abstract]:the first part Short-term prognosis and risk factors of acute renal injury in the aged Objective To observe the short-term prognosis and risk of AKI in elderly patients with acute renal injury (AKI). Methods:232 patients with AKI from January 2008 to December 2009 in the old ward of the General Hospital of the PLA were selected as the subjects, and the patient's medical records were divided into the death group and the surviving group according to the survival condition of the patients after the period of AKI to 28d and the period from 29d to 3 months. The group was analyzed, and the factors influencing the prognosis were screened by t-test or Pearson X2 test. The multivariate logistic regression analysis of the independent variables was performed to judge the death of each factor. The impact of the risk was found in 232 elderly patients with AKI, including 215 males,17 females, mean age (86.7% 5.3) years,38 cases (16.4%) in 28 days, and 19 deaths in 29 d to 3 months. (9.8%). The infection (43.1%) was the most common cause of AKI, and the other causes were hypovolemia (19%), nephrotoxicity (16.8%), and cardiovascular events (8%). The multivariate logistic regression analysis showed that the low body mass index (BMI), oliguria, mechanical ventilation, serum albumin (Alb) decreased, and the peak value of serum myoglobin (Scr) (246.5. mu.mol/ L) was the factor that affected the prognosis of the elderly patients with AKI (all P0.05). 5) The decrease of low BMI, Alb and the increase of blood urea nitrogen (BUN) are the factors that affect the prognosis of patients with AKI in the aged from 29d to 3 months. Conclusion Infection, low blood volume, nephrotoxic drugs and cardiovascular events are the most common causes of AKI in the elderly. Low BMI, oliguria, mechanical ventilation, Alb decrease, BUN increase, and Scr peak (246.5. mu.mol/ L) are the most common causes of AKI in the elderly. Patient's prognosis Risk factors. After mechanical ventilation in the second part of the patient The purpose of the analysis of the risk factors of acute renal injury was to follow up the elderly patients with mechanical ventilation and to analyze the acute renal injury (AKI) after mechanical ventilation in the elderly. Methods:260 cases of mechanical ventilation in the old ward of the General Hospital of the PLA from January 2008 to December 2012 were selected as the study subjects, and the AKI score after mechanical ventilation was determined. The analysis of AKI group and non-AKI group was carried out. The factors influencing the prognosis were first screened by single factor analysis, and the statistical significance of the factors was Logistic regression with the independent variables. The effect of each factor on AKI was determined, and the average age of 260 patients with mechanical ventilation was 88.9 (5) years; after mechanical ventilation, a total of 1 25 (48.1%) of the patients had AKI. After mechanical ventilation, A The average time of KI (1.6 to 0.7) days. The age, body mass, The difference of the mass index (BMI) was not statistically significant. The patient was associated with coronary heart disease, chronic obstructive pulmonary disease, and the proportion of hypertension was a little in the AKI group. The difference was statistically significant (P = 0.012, P = 0.040) in the AKI group compared with the non-AKI group (P = 0.012, P = 0.040). .7 (12.8, 63.6, 14.1, P = 0.021) and Oxygenation Index (PaO2/ FiO2) (122.5, 42.0, 145.7, 46.0, P = 0.000), hemoglobin (105,23,100,17, P = 0.046), blood glucose level (10.2, 4.1, 8.8, 3.7, P = 0.0) The incidence of AKI was higher (21.6% vs 10.4%) and the difference was statistically significant (P = 0.013). The multivariate logistic regression analysis showed that CKD (OR = 1.964), hyperglycemia (OR = 1.076), low PaO2/ FiO2 (OR = 2.14) 2) and the high PEEP (1994cmH2O, OR = 0.990) is the occurrence of A in the elderly patients after mechanical ventilation The main risk factors of KI (P0.05). Conclusion The incidence of AKI was 48.1% after mechanical ventilation in the aged patients, and the high PEEP was used in the treatment of CKD, hyperglycemia, low PaO2/ FiO2 and the treatment. receiving machine Independent risk factors for AKI after ventilation. Part 3 The purpose of the analysis of short-term prognosis and risk factors for the elderly patients with mechanical ventilation for elderly patients with mechanical ventilation The short-term prognosis and risk factors of mechanical ventilation were analyzed by follow-up observation, and 270 mechanical ventilation patients from January 2008 to June 2013 in the old ward of the General Hospital of the Liberation Army were selected as the study subjects, and according to the period of 28d after mechanical ventilation and from 29d to 3 months, The survival of the patients was analyzed, the data of the patient was divided into the death group and the survival group, and the factors influencing the prognosis were screened by single factor analysis. Logistic regression analysis to determine the effect of each factor on the risk of death. The average age of 270 elderly patients with mechanical ventilation (89.0-4.8) was the most common cause of mechanical ventilation. The other causes were acute left heart failure (10.7%) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 7.8%). 40 patients (21.7%) died within 29 d to 3 months (31.9%). The multivariate logistic regression analysis showed that the hypoxia-combined index (PaO2/ FiO2), prealbumin (Pre-Alb) decreased, blood urea nitrogen (BUN) increased, serum myoglobin (Scr) increased (165.2. mu.mol/ L), and positive positive pressure (PEEP) was used. The risk factors that affect the prognosis of the patients with mechanical ventilation in the aged (all P0.05), chronic kidney disease (CKD) and C-reactive protein (CRP) are the factors that affect the old age. Lung infection, acute left heart failure, AECOPD, etc. were the most common cause of mechanical ventilation in the elderly, and CKD, low PaO 2/ FiO2, Pre-Alb decreased, CRP, BUN increased, and Scr increased (165.2. mu.mo)
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692
【參考文獻】
相關(guān)期刊論文 前2條
1 連曉峰;;中長期機械通氣患者死亡危險因素分析[J];臨床醫(yī)學(xué);2013年01期
2 齊玉琴;伏杭江;陳雪松;張興虎;萬文輝;劉玉亭;;高齡患者肺部感染致多器官功能不全綜合征的臨床分析[J];中華保健醫(yī)學(xué)雜志;2011年03期
本文編號：2512279
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