严重颅脑损伤并发急性肾损伤的时相特征及原因分析  

Phase characteristics and the cause about acute kidney injury in the patients with severe traumatic brain injury

作　　者：鲁力[1] 文玉明[1] 马渝[1] 邓建平[1] 

机构地区：[1]重庆市急救医疗中心重症医学部,400014

出　　处：《中国急救医学》2010年第12期1082-1085,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的 总结严重颅脑损伤并发急性肾损伤（AKI）的发生率和时间分布,探讨发生AKI的原因.方法 回顾性分析2007-01～2010-03我院收治的489例严重颅脑损伤患者资料,比较年龄、性别、动态APACHEⅡ评分、血糖、渗透压、血钠、白细胞计数、肾功能、尿量及脱水剂使用情况等因素在并发AKI患者和未并发AKI患者间的差异.结果 严重颅脑损伤患者并发AKI总发生率为22.09%,伤后5 d内、5～14 d和14 d后发生率分别为4.91%、11.25%和9.00%.5 d内发生AKI者入院24 h内APACHEⅡ评分、血糖显著升高（P〈0.01）,APACHEⅡ评分是5 d内发生AKI的独立危险因素;5～14 d发生AKI者血钠、渗透压及尿素氮显著升高（P〈0.01）,尿素氮、血钠、渗透压是5～14 d发生AKI的独立危险因素;14 d后发生AKI者年龄、同期APACHEⅡ评分、血糖、白细胞计数显著升高（P〈0.01）,APACHEⅡ评分、白细胞计数、年龄是14 d 后发生AKI的独立危险因素.结论 AKI在严重颅脑损伤患者中发病率较高,而不同病程阶段出现AKI的原因可能不同.Objective To estimate the morbidity and the time distribution of acute kidney injury （AKI） in the patients with severe traumatic brain injury（STBI） and to explore the related risk factors. Methods The clinical data of 489 cases with STBI from Janual7 2007 to March 2010 in our hospital were retrospectively analyzed and several clinical indicators including age, gender, dynamic APACHE Ⅱ score, blood sugar, blood osmotic pressure, sodium, white blood cells count, renal function and the use of dehydrating agent were compared between the patients with AKI and those without AKI. Results The morbidity of AKI was 22.09%. According to the time of occurrence, the incidence rates were 4. 91% within 5 days（5 days group）, 11.25% from 5 to 14 days（5 - 14 days group） and 9. 00% after 14 days （14 days group） respectively. APACHE Ⅱ score and blood sugar in 5 days group, sodium, blood osmotic pressure and blood urine nitrogen in 5 - 14 days group and age, APACHE Ⅱ score, blood sugar and white blood ceils count in 14 days group were increased significantly（P 〈 0. 01 ）. Conclusion The morbidity of AKI in the patients with STBI was high and the cause of AKI in different period might be different.

关 键 词：严重颅脑损伤 急性肾损伤 特征 Logistics回归分析 

分 类 号：R651.15[医药卫生—外科学]