重症加强治疗病房妊娠期急性肾衰竭危险因素分析  

Analysis of risk factors associated with acute renal failure in critically ill obstetric patients in intensive care unit

作　　者：李海红[1] 潘秀丽[2] 张瑶[1] 王清文 谢凤杰[1] 

机构地区：[1]牡丹江医学院红旗医院重症医学科,黑龙江牡丹江157011 [2]牡丹江医学院红旗医院临床技能中心,黑龙江牡丹江157011 [3]牡丹江市传染病医院,黑龙江牡丹江157011

出　　处：《中国中西医结合急救杂志》2015年第3期284-287,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：黑龙江省自然科学基金资助项目（H201435）

摘　　要：目的分析导致重症加强治疗病房（mu）危重孕产妇妊娠期急性肾衰竭（ARF）的危险因素。方法采用回顾性分析方法，选择因产后并发症人住ICU的危重孕产妇192例，排除3例因羊水栓塞死亡，7例因记录不完整者，共182例纳入本研究。将患者根据是否合并ARF分为ARF组（68例）和非ARF组（114例），采集两组患者发生先兆子痫、HELLP综合征（溶血、肝酶升高、血小板减少）、妊娠急性脂肪肝、产后出血、脓毒症等指标；以及产后4d内使用的主要药物：①血浆体积膨胀剂：液体（晶体液、人工胶体、高渗白蛋白、4％白蛋白）和血液制品（浓集红细胞、浓缩血小板、纤维蛋白原、新鲜冷冻血浆、活化因子Ⅶ）；②抗纤溶药：氨甲环酸；③抗高血压药物：血管紧张素转换酶抑制剂（ACEI），利尿剂；④肾毒性药物：氨基糖昔类，造影剂等。对上述指标先进行单因素分析，将有统计学意义的危险因素进行多因素logistic回归分析，筛选出ICU危重孕产妇妊娠期发生急性肾衰竭的危险因素。结果单因素分析表明：HELLP综合征、产后4h使用氨甲环酸和高渗白蛋白是ARF的危险因素（x2值分别为4．92、4．29、5．53，均P〈O．05）。多因素logistic回归分析表明：HELLP综合征[优势比（OR）=10．478，95％可信区间（95％CI）为1．248～17．953，P=0．030]和产后4h使用高渗白蛋白（OR=6．632，95％C1为1．211～16．328；P=0．029）是ARF发生的独立危险因素。结论ICU危重孕产妇ARF是多因素参与的过程，应充分认识各种危险因素对ARF的影响，存在HELLP综合征和产后4h使用高渗白蛋白是ARF发生的独立危险因素，对存在危险因素的患者实施重点防护以减少ARF的发生。Objective To analyze ihe risk factors associated with acute renal failure （ARF） in critically ill obstetric patients in intensive care unit （ICU）. Methods A retrospective analysis of 192 critically ill obstetric patients admitted to the ICU for postpartum complications was conducted. There were 10 patients excluded because 3 died of amniotic embolism with massive hemorrhage in ICU and 7 had incomplete records, therefore, only 182 critically ill obstetric patients were enrolled in this study. According to the occurrence of ARF or not, the patients were divided into ARF group （68 cases） and non-ARF group （114 cases）. The indicators of preeclampsia, HELLP syndrome （hemolysis, elevated liver enzymes, thrombocytopenia）, acute fatty pregnancy liver, postpartum hemorrhage, sepsis were collected in the two groups. The main drugs used in the 4 days after delivery were as follows： （1） plasma volume expanders： fluids （crystalloids, artificial colloids, hypertonic albumin and 4% serum albumin） and blood products （packed red cells, concentrated platelets, fibrinogen, fresh frozen plasma and activated factor VII ）; （~） antifibrinolytic drug： tranexamic acid; （~） anti-hypertensive drugs： angiotensin-converting enzyme inhibitors （ACEI）, diuretics; （~） nephrotoxic drugs： aminoglycosides, contrast agent. The above indexes were firstly analyzed by the univariate method, and the risk factors with statistical significance were further analyzed by multivariate logistic regression method to screen out the independent risk factors of developing ARF in critically ill obstetric patients in ICU. Results Univariate analysis showed that HELLP syndrome, tranexamic acid and hypertonic albumin infusion used in 4 days after delivery were the risk factors of ARF （X 2 value was 4.92, 4.29, 5.53, respectively, all P 〈 0.05）. The multivariate logistic regression analysis showed： HELLP syndrome [odds ratio （OR） = 10.478, 95% confidence interval （95%C/） was 1.248 - 17.953, P = 0

关 键 词：危重孕产妇 肾衰竭 急性 HELLP综合征 高渗白蛋白 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]