ICU内急性肾损伤患者的预后指标分析  

Analysis on prognostic indicators of acute kidney injury in intensive care uint

作　　者：石海鹏[1] 徐道妙[2] 王国恩[1] 

机构地区：[1]西安交通大学第二附属医院ICU,西安710004 [2]中南大学湘雅医院ICU

出　　处：《中华急诊医学杂志》2010年第4期409-412,共4页Chinese Journal of Emergency Medicine

摘　　要：目的通过分析重症医学科（intensive care uint，ICU）内急性。肾损伤（acutekidney injury，AKI）患者高病死率的影响闪素，筛选与其相关的临床预后指标。方法回顾性分析2008年3月至2009年8月在西安交通大学第二附属医院和中南大学湘雅医院ICU内收治的符合急性肾损伤诊断标准患者的临床资料，排除ICU未满24h死亡患者、既往慢性。肾脏病史及资料不完整的患者，按60d生存状态将患者分为存活组和病死组，统计其性别，年龄、慢性疾病史、24h内相关临床化验指标（血常规、血气分析、肝肾功能、血清胱抑素C浓度，血电解质等）的最差值，并对其进行急性病理生理学和慢性健康评价（APACHE）Ⅱ评分及确诊后60d病死率。采用t检验、X^2检验行两组间变量的差异比较，再应用单因素Logistic回归分析，计算比值比（OR）和95％可信区间（CI），并对筛选出的危险因素进行多因素Logistic回归分析各种因素与病死率之间的关系。结果纳入病例98例，男60例，女38例，年龄19～89岁，（52．4±16．1）岁；到确诊后60d为止，死亡34例，死亡率34．7％。病死组患者A—PACHEⅡ评分（17．4±4．3）分高于存活组（14．2±4．8）分，P〈0．05。血清胱抑素（CystatinC）〉1．3mg／L的AKI患者死亡率为50％（24／48），高于血清CystatinC〈1．3mg／L的患者（20％，10／50；P〈0．05）。单因素分析显永，器官衰竭数目≥2个，少尿，APACHEⅡ〉15分，CystatinC〉1．3mg／L、CystatinC〉1．3mg／L＋APACHEⅡ〉15分与AKI患者死亡率相关，Logistic多因素回归分析显示：器官衰竭数目≥2个、少尿、CystatinC〉1．3mg／L结合APACHEⅡ〉15分是急性肾损伤患者的独立死亡危险因素。结论CystatinC〉1．3mg／L结合APACHEⅡ〉15分可以作为评价AKI患者预后的指标。Objective To determine the prognostic indicators of acute kidney injury by comprehensive analysis of the mortality risk factors for AKI. Method It＇ s a retrospective study. The clinical date form March 2008 to August 2009 were collected and analyzed, including gender, age, case history of chronic diseases, the worst values of laboratory examinations within 24 hours of diagnosis （including routine blood tests, blood gas analysis, liver and renal function, the levels of serum CystatinC , blood electrolytes）. According to the 60-day survival of the state will be divided into the survival group and dead groups, Calculation acute physiology and Chronic health evaluation （A- PACHE） Ⅱ scores and mortality. First, univariate analysis was used to screen the variables that related to Prognosis, Calculate odds ratias （OR） and 95 % confidence interval （CI）, then Proceeded multiple-factor anal ysis with Logistic regression among to Perform the variables. Results Of the 98 acute kidney injury cases analyzed, 60 cases were males and 38 females, age ranged form 19 to 89 years （mean age 52.4± 16.1 years）.The overall mortality was 34.7% （34/98） within 60d of final diagnosis. The APACHE ± scores of the non-survivors （ 17.4±4.3） were higher than that of the survivors（ 14.2 ± 4.8, P 〈 0.05）. The mortality of the patients with high Cystatin C（ 〉 1.3 mg/L） was 50% （24/48）, which was higher than that of the patients with low Cystatin C （ 〈 1.3 mg/L）（20%, 10/50; P 〈 0.05）. The results of the univariate analysis indicated that Organ failure t〉 2, Oliguria, APACHE Ⅱ 〉 15 scores,Cys C 〉 1.3 mg/L, Cys C 〉 1.3 mg/L Combined APACHEⅡ 〉 15 seores,were the risk factors of AKI. However the logistie reggression suggessted that Organ failure≥ 2, Oliguria, Cys C 〉 1.3 mg/L Combined APACHEⅡ〉 15 scores are the independent risk factors of AKI. Conclusions Cys C 〉 1.3 mg/L Combined APACHE Ⅱ 〉 15 seores may be used for the prognosis the patients AKI.

关 键 词：重症陕学科 急性肾损伤 血清胱抑素C 急性牛理功能和慢性健康状况评分系统Ⅱ 少尿 预后 回顺性分析 

分 类 号：R692[医药卫生—泌尿科学]