重症监护室患者发生慢性肾脏病的病因及危险因素分析  

Analysis of occurrence and risk factors of chronic kidney disease in the ICU patients

作　　者：赵郁虹[1] 吉凯强[2] 臧彬[2] 李德天[1] 

机构地区：[1]中国医科大学附属盛京医院肾内科,沈阳110031 [2]中国医科大学附属盛京医院ICU

出　　处：《中华肾脏病杂志》2013年第9期660-664,共5页Chinese Journal of Nephrology

摘　　要：目的分析重症监护室（ICU）住院患者慢性肾脏病（CKD）的发病情况及临床特点，探讨影响其发生的危险因素。方法回顾性分析2007年1月至2010年12月本院2281例ICU住院患者的临床及预后资料，排除住院期间死亡、原有CKD、资料不完整及失防者421例，其中资料完整并可配合随访的患者1860例。依据SCODRED（隐匿性肾病筛查）评分及CKD诊断标准分为CKD组与非CKD组，分析影响ICU住院患者发生CKD的危险因素。结果CKD组与非CKD组患者间在年龄、妊娠、急性肾损伤（AKI）、肝功能受损等因素方面的差异有统计学意义（P〈0．05）。ICU住院患者CKD的年患病率为20％～30％，其发病情况有随时间延长而增多的趋势。影响CKD患者预后的因素有年龄、妊娠、AKI、APACHE．II评分、有创诊疗、机械通气、器官衰竭及应用肾损害药物。结论ICU住院患者CKD患病率高，患病人数随时间的延长而增加。年龄、APACHE—Ⅱ评分〉15、器官衰竭个数≥2、肾损害药物应用种类≥2、合并妊娠、合并AKI、有创诊疗项数≥3、机械通气是ICU住院患者发生CKD的独立危险因素。Objective To analyze the occurrence and clinical features of chronic kidney disease （CKD） in the ICU patients and identify the possible risk factors. Methods A retrospective study was performed in 2281 ICU patients enrolled from Shengjing hospital between January 2007 and December 2010, in which 1860 cases had complete data and were followed-up, the other 421 cases were excluded for the reasons of dying, suffering from CKD originally, lacking complete data and missing. The cases were divided into CKD and non- CKD groups according to SCODRED and CKD diagnosis standards. Assessment was performed to screen risk factors of CKD. Results There were obvious differences between CKD and non-CKD groups at age, pregnancy, AKI and liver function （P 〈 0.05）. The CKD＇s annual morbidity rate of ICU patients was 20%-30%, and the incidence showed an increasing trend with time. Age, pregnancy, AKI, APACHE- II score, invasive diagnosis and treatment, mechanical ventilation, organ failure and kidney- hurt drugs were risk factors for CKD in the ICU patients. Conclusions The morbidity rate of CKD in the ICU patients is high, and the number of CKD patients show an increasing trend with time. Age, APACHE-II score 〉 15, the number of failed organs≥2, the variety of kidney-hurt drug≥2, pregnancy, AKI, the number of invasive diagnosis and treatment≥ 3, mechanical ventilation are independent risk factors of CKD in the ICU patients.

关 键 词：ICU 慢性肾脏病 危险因素 

分 类 号：R692[医药卫生—泌尿科学]