开颅术后危重患者急性肾损伤的发病率、危险因素及其对预后的影响  

Incidence,risk factors,and prognostic impact of acute kidney injury in critically ill patients after craniotomy

作　　者：周建芳[1] 罗旭颖[1] 张琳琳 李宏亮 杨燕琳[1] 陈光强[1] 石广志[1] Jianfang Zhou;Xuying Luo;Linlin Zhang;Hongliang Li;Yanlin Yang;Guangqiang Chen;Guangzhi Shi(Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070

出　　处：《中华重症医学电子杂志》2024年第2期148-156,共9页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：北京市卫生健康委员会“临床重点专科项目”(2100199);北京市医院管理中心重点医学专业发展计划项目(ZYLX202109);北京市科学技术委员会“首都临床诊疗技术研究及转化应用”项目(Z201100005520039)。

摘　　要：目的探讨开颅术后危重患者急性肾损伤(AKI)的发病率、危险因素及其对预后的影响。方法本研究为单中心前瞻性队列研究,纳入2017年1月至2018年12月ICU住院时间≥24 h的成年患者(排除开颅术前合并AKI者)。收集患者基础资料、主要诊断、疾病严重程度评分、并发症以及AKI患者肾功能恢复等情况。所有患者随访至出院,并记录预后信息。采用多因素回归分析筛选AKI发生的危险因素。结果共纳入907例患者,其中143例(15.8%)出现AKI。多因素回归分析显示,低基础肾小球滤过率(eGFR)、高入住ICU第1天序贯器官衰竭评估(SOFA)评分、高钠血症及休克为AKI发生的独立危险因素。AKI患者ICU住院时间[10(5,19)d vs 5(3,12)d,Z=5.836,P<0.001]及机械通气时间更长[7(3,12)d vs 4(1,8)d,Z=1.193,P<0.001],住院病死率更高(30.8%vs 6.2%,χ^(2)=80.87,P<0.001),出院时格拉斯哥预后量表(GOS)评分更低[3(2,4)分vs 4(3,5)分,Z=1.181,P<0.001]。结论AKI在开颅术后危重患者中比较常见,低eGFR、高SOFA评分、高钠血症及休克是AKI的独立危险因素。合并AKI患者的预后更差。Objective To investigate the incidence,risk factors and prognosis of acute kidney injury(AKI)in critically ill patients after craniotomy.Methods This was a single-center prospective cohort study.Adult patients who were admitted to ICU from January 2017 to December 2018 after undergoing craniotomy and had a ICU length of stay≥24 hours were included.Patients with preoperative AKI were excluded from the study.Demographics,primary diagnosis,disease severity scores,complications,and the recovery of renal function in AKI patients were recorded.All patients were followed until discharge,and information about prognosis was recorded.A multivariate regression analysis was used to identify the risk factors for AKI.Results A total of 907 patients were included,with 143(15.8%)developing AKI.Multivariable regression analysis identified a low baseline estimated glomerular filtration rate(eGFR),a high sequential organ failure assessment(SOFA)score on ICU admission day,shock,and hypernatremia as independent risk factors for AKI.Moreover,patients with AKI had longer ICU LOS[10(5,19)d vs 5(3,12)d,Z=5.836,P<0.001]and mechanical ventilation duration[7(3,12)d vs 4(1,8)d,Z=1.193,P<0.001],higher in-hospital mortality rates(30.8%vs 6.2%,χ^(2)=80.87,P<0.001),and lower Glasgow outcome scale(GOS)[3(2,4)points vs 4(3,5)points,Z=1.181,P<0.001]at discharge.Conclusion AKI is relatively common in critically ill post-craniotomy patients,with eGFR,SOFA score,shock,and hypernatremia being independent risk factors.Patients with AKI have worse outcomes.

关 键 词：急性肾损伤 开颅术后 发病率 危险因素 预后 

分 类 号：R692[医药卫生—泌尿科学]