高龄男性住院患者机械通气后并发急性肾损伤危险因素分析  

Analysis for risk factors of acute kidney injury complicated after mechanical ventilation in very elderly male inpatients

作　　者：李青霖[1] 李淑慧[2] 刘旭利 王小丹[1] 

机构地区：[1]解放军总医院南楼临床部保健科,国家老年疾病临床医学研究中心,北京100853 [2]解放军总医院南楼临床部肾内科,国家老年疾病临床医学研究中心 [3]后勤学院门诊部,北京100858

出　　处：《中华肾病研究电子杂志》2017年第5期214-218,共5页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：国家自然科学基金(81370452)

摘　　要：目的分析高龄男性患者机械通气后急性肾损伤(AKI)的发生率、相关病因及危险因素。方法选择2008年1月至2013年6月就诊于解放军总医院老年病房的260例机械通气患者为研究对象,根据机械通气后是否发生AKI分为AKI组和非AKI组进行分析。采用单因素分析初步筛查出影响预后的因素,将有统计学意义的因素作为自变量进行Logistic回归分析,判断各因素对AKI的影响。结果 260例高龄男性机械通气患者,中位年龄89岁;机械通气后共有125例(48.1%)患者发生AKI。两组患者相比,年龄、体质量指数(BMI)的差异无统计学意义(P>0.05)。患者伴有冠心病、慢性阻塞性肺疾病、高血压病史的比例在AKI组稍高于非AKI组,但差异无统计学意义(P>0.05);伴有慢性肾脏病(CKD)、糖尿病病史者,AKI组明显高于非AKI组(67.2%比51.1%,t=6.937,P=0.008;51.2%比38.5%,t=4.224,P=0.040);与非AKI组患者相比,AKI组患者Pa O2、Pa CO2和Pa O2/Fi O2明显降低,(58.2比62.5 mm Hg,t=2.729,P=0.006;46.2比51.0 mm Hg,t=2.075,P=0.038;122.5±46.0比145.7±48.6 mm Hg,t=3.944,P<0.001);尿酸、血糖(422.4比265.0μmol/L,t=7.438,P<0.001;9.4比7.7 mmol/L,t=3.505,P<0.001)水平增高;高水平呼气末正压通气(PEEP)设定值(≥4 cm H2O)在AKI组中的比例更高(21.6%比10.4%,t=16.816,P=0.013)。多因素Logistic回归分析显示伴有CKD(OR=1.976,P=0.027)病史、高尿酸(OR=1.006,P<0.001)、低Pa O2/Fi O2(OR=0.989,P=0.001)和高PEEP值(≥4 cm H2O,OR=3.146,P=0.004)是高龄男性住院患者接受机械通气后发生AKI的主要危险因素。结论高龄男性住院患者机械通气后AKI的发生率为48.1%;伴有CKD病史、高尿酸、低Pa O2/Fi O2和治疗中使用高PEEP值(≥4 cm H2O)是高龄男性住院患者接受机械通气后发生AKI的独立危险因素。Objective To explore the incidence,pathogenetic and risk factors of acute kidney injury（ AKI） complicated after mechanical ventilation（ MV） in very elderly male inpatients. Methods A total of 260 very elderly male inpatients treated with MV at the geriatric ward of Chinese PLA General Hospital from January 2008 to June 2013 were selected as subjects,and divided into AKI group and non-AKI group according to whether AKI occurred after MV. Univariate analysis was used, taking out factors influencing the prognosis. Logistic regression analysis was used,taking the statistically significant factors as independent variables in order to determine the impact of various factors on AKI. Results The median age was 89 years in the 260 very elderly inpatients treated with MV,among whom 125 patients（ 48. 1%）suffered from AKI after MV. There was no significant difference in age and body mass index（ BMI） between the two groups（ P 0. 05）. The percentages of patients with histories of coronary heart disease,chronic obstructive pulmonary disease,and/or hypertension were slightly higher in the AKI group than in the nonAKI group,but the difference was not statistically significant（ P 0. 05）. The percentage of patients with a history of chronic kidney disease（ CKD）（ 67. 2% vs 51. 1%,t = 6. 937,P = 0. 008） or diabetes（ 51. 2%vs 38. 5%,t = 4. 224,P = 0. 040） was statistically higher in the AKI group than in the non-AKI group.Compared with the non-AKI group,the AKI group showed lower Pa O2（ 58. 2 vs 62. 5 mm Hg,t = 2. 729,P =0. 006）,lower level of Pa CO2（ 46. 2 vs 51. 0 mm Hg,t = 2. 075,P = 0. 038）,and lower Pa O2/Fi O2,（ 122. 5 ± 46. 0 vs 145. 7 ± 48. 6 mm Hg,t = 3. 944,P 0. 001） in more patients,together with higher levels of serum uric acid（ 422. 4 vs 265. 0 μmol/L,t = 7. 438,P 0. 001） and serum glucose（ 9. 4 vs7. 7 mmol/L,t = 3. 505,P 0. 001）. The percentage of using high level of positive end-expiratory pressure（ PEEP）（ ≥4 cm H2 O） was higher in the AKI group（ 21.

关 键 词：机械通气 老年人 急性肾损伤 危险因素 

分 类 号：R459.7[医药卫生—急诊医学] R692.5[医药卫生—治疗学]