ICU妊娠重症患者预后中慢性肾脏病的发病情况及相关影响因素分析  

Incidence and Related Influencing Factors of Chronic Kidney Disease among Pregnant Women with Serious Diseases in ICU

作　　者：赵郁虹[1,2] 吉凯强[3] 臧彬[3] 李德天[1] 

机构地区：[1]中国医科大学附属盛京医院肾内科,辽宁省沈阳市110031 [2]沈阳市沈阳医学院附属中心医院肾内科,辽宁省沈阳市110031 [3]中国医科大学附属盛京医院ICU

出　　处：《中国全科医学》2013年第32期3798-3801,共4页Chinese General Practice

摘　　要：目的探讨ICU妊娠重症患者预后中慢性肾脏病(CKD)的发病情况及其相关影响因素。方法选取中国医科大学附属盛京医院成人ICU 2007—2010年诊治的妊娠重症患者358例,每例患者追踪随访至2011年。统计随访期间CKD的发生情况。根据是否发生CKD,将患者分为CKD组和非CKD组,比较两组患者的临床资料、病因构成,并采用Logistic回归分析检验妊娠重症患者发生CKD的影响因素。结果 (1)358例患者中56例发生CKD,发生率为15.6%。(2)与非CKD组比较,CKD组患者年龄大,妊娠周数少,血肌酐水平高,合并贫血、高血压、糖尿病、下肢血管疾病、蛋白尿的比例及有心脏病或脑卒中病史、充血性心力衰竭或心力衰竭病史的比例高(P<0.05)。(3)妊娠重症患者发生CKD的病因主要为:先兆子痫(33.9%,19/56)、妊高征(23.2%,13/56)和胎盘早剥(12.5%,7/56),其他病因占30.4%(17/56)。(4)Logistic回归分析显示,孕妇年龄,妊娠周数,妊娠合并急性肾损伤(AKI)、心脏病、高血压,围生儿死亡进入回归方程(P<0.05)。结论 ICU妊娠重症患者预后中CKD的发生率不容忽视;其发生CKD的主要病因为先兆子痫、妊高征和胎盘早剥;高龄,妊娠时间短,妊娠合并AKI、心脏病、高血压,围生儿死亡是妊娠重症患者预后中发生CKD的危险因素。Objective To investigate the incidence and related influencing factors of chronic kidney disease （CKD） among pregnant women with serious diseases in ICU. Methods A total of 358 pregnant women with serious diseases who were admitted to aduh ICU in Shengjing Hospital of China Medical University from 2007 to 2010, were selected and followed up until 2011. The CKD incidence was investigated during the follow - up period. The patients were divided into CKD and non - CKD group according to CKD diagnosis standard. The clinical data and etiology were compared between two groups, and influencing factors of CKD among pregnant women with serious diseases were analysed using Logistic regression. Results （ 1 ） There were 56 cases of CKD in 358 patients, and the incidence rate was 15.6%. （2） CKD group were significantly older than non - CKD group, pregnant weeks of CKD group were significantly less than those of non - CKD group, the level of serum creatinine was sig- nificantly higher than that of non - CKD group, and the prevalences of anemia, hypertension, diabetes, lower limb vascular dis- eases and proteinuria in CKD group were significantly higher than those in non - CKD group, the proportions in history of heart disease or stroke, congestive heart failure or heart failure in CKD group were signifcantly higher than those in non - CKD group （P 〈 0.05 ）. （3） Etiology of CKD ： preeclampsia （33.9%, 19/56） , pregnancy - induced hypertension （23.2%, 13/55）, placental abruption （ 12. 5%, 7/56）, others （30. 4%, 17/56）. （4） CKD＇s influencing factors： age of pregnant women, pregnant weeks, pregnancy complicated with AKI, pregnancy complicated with heart disease, pregnancy complicated with hy- pertention and perinatal death entered into regression equation （P 〈 O. 05）. Conclusion The incidence of CKD among pregnant women with serious diseases can not be ignored. The main causes of CKD are preeclampsia, pregnancy - induced hypertension and placental abruption. Advanced age, shorte

关 键 词：妊娠 危重病 重症监护病房 肾功能不全 慢性 危险因素 预后 

分 类 号：R714.25[医药卫生—妇产科学] R692[医药卫生—临床医学]