羟乙基淀粉与重症患者急性肾损伤的相关性研究  

Investigation regarding the correlation between hydroxyethyl starch administration and acute kidney injury in critically ill patients

作　　者：汪正光[1] 张牧城[1] 汪健蕾[1] 方向群[1] 郑绍鹏[1] 张曲矗[1] 

机构地区：[1]皖南医学院附属黄山市人民医院重症医学科,安徽黄山245000

出　　处：《中华危重病急救医学》2015年第5期338-342,共5页Chinese Critical Care Medicine

基　　金：安徽省“十二五”重点培育专科建设项目（01P45）

摘　　要：目的：探讨重症患者发生急性肾损伤（AKI）的危险因素，并评价羟乙基淀粉（HES）对重症患者AKI发生的影响。方法采用前瞻性观察性研究方法，选择2012年3月至2013年10月入住皖南医学院附属黄山市人民医院重症医学科的重症患者。记录患者的人口学资料、既往史、入院后情况、病情严重程度、输血及用药情况。根据急性肾损伤协作网（AKIN）标准将入选患者分为AKI组和非AKI组，采用单因素和多因素logistic回归分析重症患者发生AKI的危险因素，并评价HES 130/0.4在其中的作用。结果研究期间医院共收治1152例患者，有314例被纳入本研究，其中89例出现AKI。按AKIN分期标准，1期59例，2期19例，3期11例。单因素分析结果显示：年龄、合并高血压、合并糖尿病、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA）、 SOFA凝血评分、 SOFA神经评分、 SOFA心血管评分、入重症加强治疗病房（ICU）时pH值、入ICU时血糖水平、 HES总剂量和出现休克是重症患者发生AKI的危险因素（P＜0.05或P＜0.01）；而使用HES和HES每日最大剂量不是重症患者发生AKI的危险因素（均P＞0.05）。多因素logistic回归分析显示：SOFA总分〔优势比（OR）＝1.20，95%可信区间（95%CI）＝1.09～1.32，P＜0.001〕、合并高血压（OR＝2.44，95%CI＝1.22～4.89，P＝0.012）、入ICU时血糖水平（OR＝1.85，95%CI＝1.32～2.59，P＜0.001）、出现休克（OR＝3.81，95%CI＝1.93～7.53，P＜0.001）是重症患者发生AKI的独立危险因素，而HES总剂量不是重症患者发生AKI的独立危险因素（OR＝0.77，95%CI为0.68～0.87，P＜0.001）。结论 SOFA总分、合并高血压、入ICU时血糖水平、出现休克是重症患者发生AKI的独立危险因素，而HES可能不是重症患者发生AKI的独立危险因素。ObjectiveTo explore the risk factors of the occurrence of acute kidney injury （AKI） in critically ill patients, and to investigate the effect of hydroxyethyl starch （HES） on renal function in these patients.Methods A prospective investigation was conducted. Critically ill patients admitted to Department of Critical Care Medicine of People＇s Hospital of Huangshan, Wannan Medical College from March 2012 to October 2013 were enrolled. For all the patients under observation, the following data were collected： demography, comorbidities, clinical presentation, severity of illness, and the use of blood product and drugs. All patients were divided into AKI group and non-AKI group by means of Acute Kidney Injury Network （AKIN） criteria, then the risk factors of AKI were investigated by means of univariate and multivariate logistic regression analysis. The effect of HES 130/0.4 administration on renal function in critically ill patients was evaluated.Results 314 patients were enrolled for study out of 1 152 patients admitted. Among these patients enrolled, 89 of them were found to suffer from AKI. AKI was classified as stage 1 in 59 patients, stage 2 in 19 patients, and stage 3 in 11 patients. It was shown by the univariate analysis that 12 variables were the risk factors of AKI, including age, hypertension, diabetes mellitus, acute physiology and chronic health evaluationⅡ （APACHEⅡ） score, sequential organ failure assessment （SOFA） score, coagulation SOFA score, neurological SOFA score, cardiovascular SOFA score, blood pH on intensive care unit （ICU） admission, blood glucose on ICU admission, accumulating dose of HES, and presence of shock （P〈0.05 orP〈0.01）. However, HES administration and daily maximum dose of HES were not the risk factors of AKI in critically ill patients （bothP〉 0.05）. Using the multivariate logistic regression analysis, it was shown that total SOFA score [odds ratio （OR） = 1.20, 95% confidence interval （95%CI） = 1.09-1.32,P〈0.001], hypertension �

关 键 词：羟乙基淀粉 急性肾损伤 序贯器官衰竭评分 血糖 高血压 休克 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]