神经外科重症患者急性肾损伤发生情况及危险因素分析  

Analysis of the incidence and risk factors of acute kidney injury in critically neurosurgical patients

作　　者：袁婕[1,2] 叶珩[3] 刘力新[4] 蓝颖茹[3] 邓宇珺[2] 池锐彬[4] 王琳[2] 翟依琳 吕波[2] 龙怡[2] 陈纯波[2] 

机构地区：[1]汕头大学医学院,广东汕头515041 [2]广东省人民医院广东省医学科学院重症医学科,广东广州510080 [3]广州市第一人民医院南沙分院广州市南沙中心医院重症医学科,广东广州511455 [4]南方医科大学附属小榄医院医院重症医学科,广东中山528415

出　　处：《中国实用内科杂志》2016年第5期393-397,共5页Chinese Journal of Practical Internal Medicine

基　　金：广东省科技计划重点项目(2014B020212023);广东省自筹经费类科技计划项目

摘　　要：目的总结神经外科重症患者发生急性肾损伤（acute kidney injury，AKI）相关危险因素。方法采用多中心前瞻性队列研究，纳入2014年3月至2015年1月广东省人民医院重症医学科神经外科重症监护室（ICU）、南方医科大学附属小榄医院1CU、广州市第一人民医院南沙分院ICU符合研究条件的神经外科重症患者663例，收集患者人口统计学资料、手术前后的临床资料和实验室检查结果，分析AKI的发生情况、临床危险因素，死亡等预后情况，通过多因素回归分析神经外科重症患者AKI发生的独立危险因素。结果AKI发生率为16．9％（112／663）。多因素Logistic回归分析显示，患者再次手术（OR7．887，95％CI1．666-37.345）、入ICU血清胱抑素C水平（OR4．226，95％CI1．948-9．166）、入ICU格拉斯哥昏迷评分（GCS）≤8分（OR2．928，95％CI1．503-5．706）、入ICU血清肌酐〉106μmol／L（OR3．422，95％CI1．518-7．714）、术中输血≥400mL（OR2．562，95％CI1418-4．627）是神经外科重症AKI发生的独立危险因素（P均〈0．05）。AKI患者的住院时间、肾脏替代治疗比例、ICU病死率、院内病死率、90d病死率明显高于非AKI者（P均〈0．05）。结论再次手术、入ICU血清胱抑素C水平、入ICUGCS评分≤8分、入ICU血清肌酐〉106μmol／L、术中输血≥400mL是神经外科重症AKI发生的独立危险因素。Objective To determine the incidence and risk factors of acute kidney injury（AKI） in critically neurosurgical patients. Methods It prospectively observed clinical data of 651 neurosurgical intensive care patients in neurosurgical intensive care unit of Guangdong Generel Hospital, Guangzhou Nansha Central Hospital, Xiao Lan Hospital of Southern Medical University from March 2014 to January 2015. Patients＇ demographics, clinical data and laboratory examinations before and after operation were collected. The incidence, clinical risk factors and mortality of AIG in critically neurosurgical patients were analyzed. Multivariate Logistic regression analysis was used to investigate the independent risk factors of AKI in these patients. Results Of the total 663 neurosurgical intensive care patients, the incidence of AKI in those patients was 16.9%. Multivariate logistic regression analysis revealed that reoperation（OR 7.887, 95%CI 1.666-37.345）, admission serum Cystatin C（OR 4.226, 95%CI 1.948-9.166）, admission GCS score ≤ 8 （OR 2.928, 95%CI 1.503-5.706）, admission serum creatinine〉 106 μmol/L（OR 3.422, 95%CI 1.518-7.714） and blood transfasion volume ≥400 mL （OR 2.562, 95%CI 1.418-4.627） are independent risk factors ofAKI （P〈0.05）. Hospital length of stay, required dialysis, the ICU mortalit）5 in-hospital mortality and 90 d mortality in AKI patients were higher than those without AKI （P〈0.05）. Conclusion Incidence of AKI is quite high in critically neurosurgical patients. AKI increases mortality. Reoperation, admission serum Cystatin C, admission GCS scored 8, admission serum creatinine 〉 106 μmol/L and blood transfusion volume ≥ 400 mL are independent risk factors of AKI.

关 键 词：肾损伤 急性 神经外科 重症患者 流行病学 危险因素 

分 类 号：R692[医药卫生—泌尿科学]