急性右心室心肌梗死患者住院期间发生肾功能恶化情况及相关因素分析  

Factors analysis of worsening renal function in patients with acute right ventricular myocardial infarction during hospitalization

作　　者：冯斯婷 范婧尧 郝鹏 白杉 王溪 贾立昕 Feng Siting;Fan Jingyao;Hao Peng;Bai Shan;Wang Xi;Jia Lixin(Emergency and Critical Care Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China;Coronary Artery Disease Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China;Heart Failure Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所急诊危重症中心,北京100029 [2]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所冠心病中心,北京100029 [3]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心力衰竭中心,北京100029

出　　处：《中华医学杂志》2022年第30期2368-2373,共6页National Medical Journal of China

基　　金：国家自然科学基金(82070407)。

摘　　要：目的分析急性右心室心肌梗死(RVMI)患者住院期间发生肾功能恶化(WRF)的相关因素。方法本研究为横断面研究,选取2011年8月至2020年1月就诊于北京安贞医院急诊综合病房的急性RVMI患者共98例。根据WRF情况分为无WRF组(76例)和WRF组(22例),WRF定义为住院第6天(住院<6 d则为出院时)血肌酐水平较基线升高≥0.3 mg/dl。获取患者基线资料、静脉补液、利尿和出入量明显正平衡[住院6 d内(住院<6 d则为入院至出院前)任意1个24 h入量较出量≥1000 ml或任意1个连续72 h入量较出量≥2000 ml]的情况,分析两组间上述指标的差异,同时采用多因素logistic回归模型分析RVMI患者住院期间发生WRF的相关因素。结果WRF组和无WRF组患者年龄分别为60(50,68)、63(52,72)岁,男性比例分别为63.6%(14例)、76.3%(58例),差异均无统计学意义(均P>0.05)。WRF组出入量明显正平衡的比例为31.8%(7例),高于无WRF组的14.5%(11例)(P=0.034);WRF组袢利尿剂使用比例为4.5%(1例),低于无WRF组10.5%(8例)(P=0.027)。调整了年龄、性别、基线估算的肾小球滤过率(eGFR)、术前异丙肾上腺素/临时起搏器/阿托品使用、出入量明显正平衡和袢利尿剂使用后发现,eGFR≥60 ml·min^(-1)·1.73 m^(-2)、出入量明显正平衡是发生WRF的相关因素,OR值(95%CI)分别为0.71(0.62~0.86)、1.21(1.02~1.43)(均P<0.05);剔除上述模型中的出入量明显正平衡变量后发现,袢利尿剂使用是发生WRF的相关因素,OR值(95%CI)为0.89(0.72~0.97)(P<0.05)。结论急性RVMI患者住院期间出入量明显正平衡是第6天或出院时发生WRF的危险因素;在出入量明显正平衡的情况下,袢利尿剂使用是发生WRF的保护因素。Objective To analyze the related factors of worsening renal function(WRF)in patients with acute right ventricular myocardial infarction(RVMI)during hospitalization.Methods A total of 98 patients with acute RVMI admitted to the emergency comprehensive ward of Beijing Anzhen Hospital from August 2011 to January 2020 were enrolled in this cross-sectional study.According to the situation of WRF,the patients were divided into non-WRF group(76 cases)and WRF group(22 cases).WRF was defined as≥0.3 mg/dL increase in serum creatinine level from baseline on day 6 of hospitalization(if hospital stay<6 days,it was at discharge).Baseline data,intravenous fluid infusion,diuretic and significant positive balance of patients′intake and output volume[any 24 h intakes and outputs≥1000 ml or any consecutive 72 h intakes and outputs≥2000 ml within 6 d of hospitalization(if hospitalization<6 d,it was from admission to discharge)]were obtained,and the differences of above indicators between the two groups were analyzed.Multiple logistic regression model was used to analyze the related factors of WRF.Results The ages of patients in WRF group and non-WRF group were 60(50,68)and 63(52,72)years,and the male proportions were 63.6%(14 cases)and 76.3%(58 cases),respectively,and there was no significant difference(all P>0.05).The proportion of positive balance was 31.8%(7 cases)in WRF group,which was higher than 14.5%(11 cases)in non-WRF group(P=0.034).The rate of loop diuretic use in WRF group was 4.5%(1 case),lower than that in non-WRF group 10.5%(8 cases)(P=0.027).After adjusting for age,sex,baseline estimated glomerular filtration rate(eGFR),preoperative isoproterenol/temporary pacemaker/atropine use,significant positive balance of intake and output volume,and loop diuretic use,it was found that eGFR≥60 ml·min^(-1)·1.73 m^(-2)and significant positive balance were associated with WRF,the OR(95%CI)were 0.71(0.62-0.86)and 1.21(1.02-1.43)(both P<0.05);After eliminating the variable of significant positive balance in the above model

关 键 词：心肌梗死 急性右心室心肌梗死 肾功能恶化 扩容 利尿 

分 类 号：R542.22[医药卫生—心血管疾病] R692[医药卫生—内科学]