急性重症脑出血并发急性肾损伤的临床分析  

Clinical Analysis of Acute Severe Cerebral Hemorrhage Complicated with Acute Kidney Injury

作　　者：刘莹 邓西龙[1] 韦广莹[1] 潘越峻[1] 梁桐 LIU Ying;DENG Xilong;WEI Guangying;PAN Yuejun;LIANG Tong(The Eighth People’s Hospital of Guangzhou,Guangzhou 510000,China)

机构地区：[1]广州市第八人民医院

出　　处：《现代医院》2019年第5期714-717,共4页Modern Hospitals

基　　金：广东省医学科研基金(A2016381);广州市科技计划项目(201607010302)

摘　　要：目的分析急性重症脑出血早期并发急性肾损伤(AKI)患者的临床特点,探讨影响其预后的因素及防治方法。方法对2017年1月—2018年7月重症医学科(ICU)收治的46例急性重症脑出血患者进行分析,入院48h内合并AKI的患者为AKI组(20例),未合并AKI的患者为对照组(26例)。收集入院时基线资料(包括性别、年龄、基础疾病、是否并发脑疝)、血流动力学参数[中心静脉压(CVP)、平均动脉压(MAP)、心率(HR)、氧合指数(OI)、血乳酸(Lac)、左室射血分数(EF)]、临床指标[急性生理学及慢性健康状况评分(APACHEⅡ评分)、格拉斯哥昏迷评分(GCS评分)、入院第一天血肌酐(Scr)和降钙素原(PCT)、住院期间最高血肌酐(Scr-max)和降钙素原(PCT-max)]、ICU住院天数及预后。对比两组的临床特点,分析有统计学差异的临床指标之间的关系和对预后的影响。结果两组患者入院时的基线资料、血流动力学参数、PCT和ICU住院天数比较差异无统计学意义(P>0.05);AKI组APACHEⅡ评分、GCS评分、Scr、Scr-max、PCT-max、脓毒症发生率和28d死亡率较对照组均明显升高,差异有统计学意义(P<0.05);Scr与Scr-max、PCT与PCT-max、Scr-max与PCT-max均呈显著正相关(P<0.05),PCT-max越高发生脓毒症的可能性越大,Scr-max越高死亡风险越高。结论合并脓毒症是导致急性重症脑出血早期并发急性肾损伤患者死亡的重要因素,密切监测Scr和PCT并及时干预可能对改善患者预后有重要意义。Objective To analyze the clinical features of patients with acute kidney injury(AKI)within 48 hours after acute severe cerebral hemorrhage,and to explore the risk factors affecting prognosis and prevention methods.Methods The investigation was done into the clinical data of46 patients with acute severe cerebral hemorrhage admitted to the Department of Critical Care Medicine(ICU)from January 2017 to July 2018.The patients with AKI within 48 hours of admission were assigned as AKI group(n=20)and those without AKI were as control group(n=26).Baseline data were collected including admission(including gender,age,underlying disease,and presence of cerebral hernia),hemodynamic parameters[Central venous pressure(CVP),mean arterial pressure(MAP),heart rate(HR),oxygenation index(OI),blood lactate(Lac),left ventricular ejection fraction(EF)],clinical indicators[acute physiology and chronic health status score(APACHE II score),Glasgow Coma Scale score(GCS score)],serum creatinine(Scr)and procalcitonin(PCT)on admission,highest serum creatinine(Scr-max)and procalcitonin(PCT-max)during hospitalization,ICU stay days and prognosis.The clinical characteristics of the two groups were compared,and the relationship between the clinical indicators with statistical differences and the impact on prognosis were analyzed.Results There was no significant difference in baseline data,hemodynamic parameters,PCT and ICU stay days between the two groups(P>0.05).The APACHE II score,GCS score,Scr,Scr-max,PCT-max,sepsis incidence and 28-day mortality in AKI group were significantly higher than those in the control group,with statistically significant difference(P<0.05).There was a significant positive correlation between Scr and Scr-max,PCT and PCT-max,Scr-max and PCT-max(P<0.05).PCT-max predicted bacterial sepsis very well,and the higher the Scr-max,the greater the risk of death.Conclusion Combined sepsis is an important risk factor in the death of patients with acute severe cerebral hemorrhage complicated with acute kidney injury.Close monitorin

关 键 词：脑出血 急性肾损伤 脓毒症 降钙素原 血肌酐 

分 类 号：R743.340.6[医药卫生—神经病学与精神病学]