急诊危重患者急性肾损伤发生的危险因素分析  

Risk factors of acute kindey injury in critical patients in emergency department

作　　者：李雪芳 金魁 田丽源 付阳阳 高健 戴佳原 朱华栋 于学忠 徐军 Li Xuefang;Jin Kui;Tian Liyuan;Fu Yangyang;GaoJian;Dai Jiayuan;Zhu Huadong;Yu Xuezhong;Xu Jun(Emergency Department State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100730,China;Department of Emergency Intensive Care Medicine The First Affiliated Hospital of USTC,Division of Life Science and Medicine,University of Science and Technology of China Hefei Anhui,236000,China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院急诊科,疑难重症及罕见病国家重点实验室,北京100730 [2]中国科学技术大学附属第一医院EICU,安徽236000

出　　处：《中华急诊医学杂志》2021年第6期749-753,共5页Chinese Journal of Emergency Medicine

摘　　要：目的调查急诊抢救室患者急性肾损伤(acute kindey injury,AKI)的发生率并探讨相关危险因素。方法采用回顾性队列研究方法,纳入2018年9-12月经由本院抢救室收治的患者,根据患者入院后7 d内是否发生AKI,将患者分为AK1组和非AKJ组。收集患者人抢救室时的人口学特征、APACHE Ⅱ评分、是否使用肾脏毒性药物、24 h液体出入量及院内生存时间等相关指标。使用多因素Logistic回归分析AKI发生的危险因素。使用COX回归研究AKI的发生对患者住院生存率的影响,并分析AKI严重程度对患者死亡风险的影响。结果纳人急诊抢救室的患者238例,其中108例发生AKI(45.4%),AKI 1期83例(34.9%),AKI2-3期25例(10.5%)。APACHE Ⅱ评分>13分[OR=1.11,95%C7(1.07~1.16),P<0.01],应用血管活性药[OR=2.20,95%CI(1.08-4.49),P=0.03],糖尿病(OR=2.33,95%CI(1.23-4.42),P=0.01),24 h入量>3 L(OR=3.10,95%CI(1.17-8.25),P=0.02)是发生AKI的独立危险因素:多因素COX回归校正APACHE Ⅱ评分和年龄后,AKI仍是急诊抢救室患者死亡的独立危险因素,且AICI严重程度显著增加急诊患者死亡风险[AKI1期HR=1.45,95%CI(1.08-2.03),<P=0.04;AKI2-3期HR=3.15,95%C7(1.49-4.81),P=0.03]。结论急诊抢救室患者中AKI的发生较常见。APACHE Ⅱ评分>13分,应用血管活性药,糖尿病,24h人量>3 L是发生AKI的独立危险因素3随着AKI严重程度的增加,死亡风险增加。Objective To investigate the incidence and risk factors of acute kidney injury in patients admitted to the resuscitation room of the Emergency Department.Methods Patients were enrolled from the resuscitation room of our hospital from September to December 2018 by a retrospective cohort study.Patients were divided into AKI group and non-AKI group according to whether AKI occurred within seven days after admission.Demographic characteristics,APACHE II score,whether to use nephrotoxic drugs,24-hour fluid volume,and patients survival time were collected.Multivariate regression analysis was used to explore the risk factors for AKI.Cox regression was used to study the effect of the occurrence of AKI on survival and to analyze the influence of AKJ severity on the death risk of patients in the resuscitation room.Results Among 238 critical patients who were finally included,108 patients developed AKI(45.4%),83 patients were in AKI stage 1(34.9%),and 25 patients were in AKI stage 2-3(10.5%).APACHE Ⅱ score>13(0R=1.11,95%C/(1.08-1.16),P<0.01),vasoactive drugs(OR=2.20,c95%C7(1.08-4.49),P=0.03),diabetes mellitus(OR=2.33,95%CI(1.23-4.42),P=0.01),and fluid load>3 L(OR=3.10,95%CI(1.17-8.25).P=0.02)were independent risk factors for AKI.After adjustment for APACHE Ⅱ score and age by multivariate COX regression,AKI remained an independent risk factor for death in emergency patients,and the severity of AKJ significantly increased the risk of death in these patients(AKI1:HR=1.45,95%CI(1.08-2.03),P=0.04;AKI 2-3:HR=3A5,95%CI(1.49-4.81),P=0.03).Conclusions AKI occurred commonly in the resuscitation room of the emergency department.APACHE II score>13,vasoactive drugs,diabetes,and fluid load>3 L were independent risk factors for AKI.The risk of death increased with the aggravation of AKI severity.

关 键 词：急性肾损伤 危险因素 急诊科 发生率 预后 容量 APACHEⅡ评分 血管活性药 糖尿病 

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