本文選題：腦出血 + 急性腎衰竭��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 急性腎衰竭（Acute renal failure ARF）是高血壓腦出血術(shù)后常見的并發(fā)癥之一，越來越受到臨床醫(yī)師的重視，也給神經(jīng)外科術(shù)后常用藥像甘露醇、抗生素的應(yīng)用帶來限制，嚴(yán)重影響患者的預(yù)后，加重了患者住院時(shí)間及經(jīng)濟(jì)負(fù)擔(dān)。因此，積極探索腦出血術(shù)后ARF的危險(xiǎn)因素，為尋找有效的預(yù)防及治療措施提供依據(jù)。方法： 收集我院神經(jīng)外科高血壓腦出血術(shù)后患者230例，對其危險(xiǎn)因素進(jìn)行分析，選用Excel軟件建立數(shù)據(jù)庫，使用SAS.8.02統(tǒng)計(jì)分析軟件進(jìn)行變量的賦值及統(tǒng)計(jì)分析。單因素分析時(shí)計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(x±S)表示，計(jì)數(shù)資料采用X2檢驗(yàn)，多因素分析采用Logistics回歸分析，P＜0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果: 按照ARF的診斷標(biāo)準(zhǔn)，回顧性分析了230例病例，術(shù)后發(fā)生了ARF75例。單因素分析：發(fā)生ARF組患者的平均年齡（57.75+10.26）高于未發(fā)生ARF組（45.63+11.59）；發(fā)生ARF組的平均ICU住院天數(shù)（7.43±4.65）明顯高于未發(fā)生ARF組（3.11±4.12）；手術(shù)時(shí)間越長，，術(shù)后ARF發(fā)生率越高，手術(shù)時(shí)間＜2h，術(shù)后ARF發(fā)生率16.67%，手術(shù)時(shí)間2h～4h，術(shù)后ARF發(fā)生率22.92%，手術(shù)時(shí)間4h～6h，術(shù)后ARF發(fā)生率36.08%，手術(shù)時(shí)間＞6h，術(shù)后ARF發(fā)生率64.00%；術(shù)后GCS評分3~8分、9~12分、13~15分患者的術(shù)后ARF發(fā)生率分別為48.52%、31.68%、16.39%；術(shù)后發(fā)生ARF的患者平均甘露醇總劑量（5280.42g）高于未發(fā)生ARF患者的甘露醇總劑量（3523.76g）；術(shù)后抗生素應(yīng)用時(shí)間越長，術(shù)后ARF發(fā)生率越高；術(shù)后輸血的患者ARF發(fā)生率（43.69%）高于未輸血的患者（23.62%）。 多因素非條件的logistic回歸分析結(jié)果顯示甘露醇總劑量、抗生素應(yīng)用時(shí)間、術(shù)后GCS評分是高血壓腦出血術(shù)后發(fā)生ARF的獨(dú)立危險(xiǎn)因素。 結(jié)論： 患者年齡、手術(shù)時(shí)間、ICU住院時(shí)間、術(shù)后體溫、術(shù)后輸血是高血壓腦出血術(shù)后發(fā)生ARF的危險(xiǎn)因素；術(shù)后應(yīng)用甘露醇總劑量，術(shù)后GCS評分，術(shù)后應(yīng)用抗生素時(shí)間是高血壓腦出血術(shù)后發(fā)生ARF的獨(dú)立危險(xiǎn)因素；參考既往報(bào)告其他疾病術(shù)后與ARF關(guān)系，說明腦出血是特殊疾病，治療期間需要有特殊的治療方式。腦出血后合并ARF不是孤立于腦出血的泌尿系統(tǒng)疾病，ARF是腦出血疾病的一個(gè)表現(xiàn)層面。
[Abstract]:Objective: Acute renal failure ARF) is one of the common complications after hypertensive intracerebral hemorrhage, which is paid more and more attention by clinicians. It also restricts the use of common drugs such as mannitol and antibiotics after neurosurgery, and seriously affects the prognosis of patients. Increased patient hospitalization time and economic burden. Therefore, we should explore the risk factors of ARF after intracerebral hemorrhage and provide evidence for effective prevention and treatment. Methods: A total of 230 patients with hypertensive intracerebral hemorrhage after neurosurgery in our hospital were collected and their risk factors were analyzed. Excel software was used to establish the database and SAS.8.02 statistical analysis software was used to assign and analyze the variables. In univariate analysis, the measurement data were expressed as mean 鹵standard deviation (x 鹵S), the count data were measured by X2 test, and the multivariate analysis was performed by Logistics regression analysis (P < 0. 05). Results: According to the diagnostic criteria of ARF, 230 cases of ARF75 were analyzed retrospectively. Univariate analysis showed that the average age of ARF group was 57.75 10.26) higher than that of ARF group (45.63 11.59), the average ICU hospitalization time of ARF group was 7.43 鹵4.65) and the average ICU hospitalization time of ARF group was 3.11 鹵4.120.The longer the operation time, the higher the incidence of postoperative ARF. The operative time was less than 2 hours, the postoperative ARF rate was 16.67 hours, the operative time was 2 hours and 4 hours, the postoperative ARF rate was 22.922 hours, the operative time was 4 hours and 6 hours, the postoperative ARF rate was 36.08 hours, the operative time was more than 6 hours, the postoperative ARF incidence rate was 64.00; the postoperative GCS score was 3 ~ 8 points, 9 ~ 12 minutes and 13 ~ 15 minutes, respectively. The average total dose of mannitol in patients with ARF after operation was 5280.42g), which was higher than that in patients without ARF (3523.76g). The higher the incidence of postoperative ARF, the higher the incidence of ARF in the patients with postoperative blood transfusion (43.69%) than in the patients without blood transfusion (23.62%). The results of multivariate non-conditional logistic regression analysis showed that the total dose of mannitol, the time of antibiotic use and the postoperative GCS score were independent risk factors for ARF after hypertensive intracerebral hemorrhage. Conclusion: Age, operation time, postoperative body temperature, postoperative blood transfusion were the risk factors of ARF after hypertensive intracerebral hemorrhage, total dose of mannitol, postoperative GCS score, total dose of mannitol after operation, The time of application of antibiotics was an independent risk factor for ARF after hypertensive intracerebral hemorrhage, and the relationship between ARF and other diseases was reported in the past, which indicated that ICH was a special disease and special treatment was needed during the period of treatment. ARF after intracerebral hemorrhage is not a urological disease isolated from intracerebral hemorrhage.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.34;R692.5

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