急性肾损伤网络工作组分级系统评估重型创伤性脑损伤患者急性肾损伤的临床研究  

Acute kidney injury network classification system for evaluation of acute kidney injury in patients with severe traumatic brain injury

作　　者：徐福林[1] 张义[1] 王建清 李宁[3] 

机构地区：[1]复旦大学附属第五人民医院神经外科,上海200240 [2]上海市瑞金医院集团闵行医院神经外科,上海200240 [3]上海交通大学医学院附属瑞金医院神经外科,上海200240

出　　处：《中华创伤杂志》2013年第11期1053-1057,共5页Chinese Journal of Trauma

摘　　要：目的采用急性肾损伤网络工作组（acute kidney injury network，AKIN）分级系统评估重型创伤性脑损伤（severe traumatic brain injury，sTBI）患者的急性肾损伤（acute kidney injury，AKI）发生率、严重程度、危险因素及其对预后的影响。方法回顾性分析2007年1月-2011年5月收治的136例sTBI患者的临床资料。记录患者的一般资料、人院时有无脑疝、收缩压和平均动脉压、血清肌酐和尿素氮、血糖、6个月后的治疗结果及死亡率，并通过AKIN标准评估肾功能。根据是否合并AKl分为非AKI组和AKI组；根据AKI严重程度分为AKI1级组、AKI2级组和AKI3级组，分析组间的差异。结果经AKIN分级系统，本组31例患者（23％）诊断为AKI，其中1级组21例（68％），2级和3级组10例（32％）。高龄、入院时GCS低、人院时血清肌酐及尿素氮水平高的患者易发生AKI。合并AKI的TBI患者，较肾功能正常的TBI患者死亡率高、治疗效果差。结论AKI是sTBI患者的常见并发症之一，采用AKIN分级系统可早期发现sTBI患者AKI并可能有助于改善患者的预后。Objective To evaluate the incidence, severity, risk factors and impact to prognosis of acute kidney injury （AKI） in patients with severe traumatic brain injury （sTBI） by using acute kidney injury network （AKIN） classification system. Methods A retrospective analysis was carried out in 136 patients with sTBI hospitalized between January 2007 and May 2011. Demographic data, admission evaluation （whether with hernia or not on admission, systolic pressure and mean arterial blood pressure, serum creatinine and urea nitrogen, and blood glucose） , outcome at 6 months post-injury and mortality were collected. Renal function was assessed using AKIN criteria. The patients were divided into two groups based on the presence or absence of AKI （non-AKI group and AKI group）. According to the se- verity of AKI, AKI group was further classified as AKI grade 1 group, AKI grade 2 group and AKI grade 3 group. The differences among groups were analyzed. Results According to AKIN classification sys- tem, 31 （23%） out of the 136 patients were diagnosed as being with AKI, including 21 cases （68%） in AKI grade 1 group and 10 cases （32%） in AKI grade 2 and 3 groups. The patients at older age and with lower Glasgow coma scale （GCS） on admission, higher levels of serum creatinine and blood urea nitrogen on admission were prone to AKI. As compared with TBI patients with normal renal function, TBI patients associated with AKI had higher mortality and worse outcome. Conclusions AKI is a common compli- cation of patients with sTBI. AKIN classification system can early diagnose AKI in sTBI patients and may contribute to improvement of the outcome.

关 键 词：脑损伤 肾功能不全 预后 

分 类 号：R651.15[医药卫生—外科学]