术后镇痛应用复方双氯芬酸钠注射液患者发生急性肾损伤风险及相关因素分析  

Analysis on risk and related factors of acute renal injury in patients with compound diclofenac sodium injection treatment after surgeries

作　　者：朱艳[1] 徐萍[1] 王清[1] 罗建权 肖轶雯[1] 周艳钢[1] 李一意 

机构地区：[1]中南大学湘雅二医院药学部/临床药学研究所,长沙410011

出　　处：《药物不良反应杂志》2017年第6期420-424,共5页Adverse Drug Reactions Journal

摘　　要：目的 了解术后使用复方双氯芬酸钠注射液患者发生急性肾损伤（AKI）的风险并探讨相关因素.方法 收集2015年中南大学湘雅二医院非肾脏外科手术后使用复方双氯芬酸钠注射液、用药前肾功能正常患者的病历资料进行回顾性调查（非配对病例对照研究）.将用药后发生AKI的患者纳入病例组,未发生AKI的患者纳入对照组,比较2组患者的一般情况、术后用药情况和用药前后肾功能情况,分析使用复方双氯芬酸钠注射液后发生AKI的风险及相关因素.结果 纳入分析的患者为821例,病例组63例[男性43例,女性20例,平均年龄（51±13）岁],对照组758例[男性425例,女性333例,平均年龄（50±14）岁].病例组患者中合并高血压、肝硬化者占比高于对照组[25.4％（16/63）比13.1％（99/758）,P=0.009;9.5％（6/63）比2.8％（21/758）,P=0.013],行普通外科手术者占比高于对照组[42.9％（27/63）比26.9％（204/758）,P=0.007],行神经外科手术者占比低于对照组[15.9％（10/63）比33.5％（254/758）,P=0.004],手术结束至使用复方双氯芬酸钠注射液间隔时间≤24 h者占比高于对照组[20.6％（13/63）比10.7％（81/758）,P=0.017].二元Logistics回归分析结果显示,合并高血压患者发生AKI风险明显高于合并其他疾病患者（OR=2.847,95％CI：1.498～5.410,P=0.001）;术后24 h内使用复方双氯芬酸钠注射患者发生AKI风险明显高于24 h后使用该药患者（OR=1.956,95％CI：1.154～3.315,P=0.013）.结论 术后镇痛使用复方双氯芬酸钠注射液的患者可发生AKI,合并高血压和术后24 h内使用该药可明显增加AKI发生风险.Objective To understand the risk of acute renal injury （AKI）in patients using compound diclofenac sodium injection after surgeries and analyze the influencing factors. Methods Data of patients who had normal renal function before receiving compound diclofenac sodium injection treatment after surgeries in 2015 in the Second Xiangya Hospital of Central South University were collected and studied retrospectively （unmatched case-control study）. The patients with AKI after treatment were included in the case group and the patients without AKI were included in the control group. The general condition, postoperative medication,and renal function before and after medication in the 2 groups were compared. The risk and related factors of AKI using compound diclofenac sodium injection were analyzed. Results A total of 821 patients were enrolled into this study,including 63 cases in the case group [43 males and 20 females,average age（51 ± 13）years]and 758 cases in the control group [425 males and 33 females, average age（50 ±14）years]. The proportion of patients with hypertension and liver cirrhosis in the case group was higher than that in the control group [25. 4% （16/ 63）vs. 13. 1% （99/ 758）,P =0. 009;9. 5%（6 / 63） vs. 2. 8% （21 / 758）,P = 0. 013],the proportion of patients with general surgeries in the case group was higher than that in the control group [42. 9%（27 / 63）vs. 26. 9% （204 / 758）,P = 0. 007],the proportion of patients with neurosurgery in the case group was lower than that in the control group [15. 9%（10 / 63）vs. 33. 5% （254 / 758）,P = 0. 004],the proportion of patients using compound sodium diclofenac injection within 24 h after operation in the case group was higher than that in the control group [20. 6%（13 / 63）vs.10. 7%（81 / 758）,P = 0. 017]. The results of binary logistic regression analysis showed that the risk of AKI in patients with hypertension was significantly higher than the other patients with other diseases （OR =2. 847,95% CI：1. 498-5

关 键 词：甲氯芬那酸 对乙酰氨基酚 急性肾损伤 

分 类 号：R692[医药卫生—泌尿科学]