新疆维吾尔自治区重症患者急性肾功能异常的危险因素分析  

Critically ill patients with acute renal dysfunction in Xinjiang Uygur Autonomous Region:A crosssection study

作　　者：李文哲 王毅[1,2] 崔建 郑启航 王靖彦 于湘友 Li Wenzhe;Wang Yi;Cui Jian;Zheng Qihang;Wang Jingyan;Yu Xiangyou(Department of Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Xinjiang Key Laboratory of Medical Animal Model Research,Urumqi,830054,China)

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆维吾尔自治区乌鲁木齐830054 [2]新疆医学动物模型研究重点实验室,新疆维吾尔自治区乌鲁木齐830054

出　　处：《中华卫生应急电子杂志》2024年第5期269-276,共8页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金：国家重点研发计划(2021YFC2500800);国家自然科学基金(82160360)。

摘　　要：目的明确新疆地区重症患者肾功能异常的发病率及相关影响因素,为新疆地区重症医学医疗质量改进和专项培训工作提供循证医学证据。方法本研究采用前瞻性多中心横断面调查研究的方法,对2024年1月31日当日新疆重症联盟重症医学科(ICU)收治的成人重症患者进行筛查,纳入符合标准的患者进行急性肾功能异常的危险因素分析。结果调研中共计77所ICU参研,纳入重症患者591例,其中男性239例,女性352例;年龄18~101岁,平均(64.0±18.1)岁。肾功能正常患者459例(77.7%)、急性肾功能异常患者132例(22.3%)。分析结果显示,年龄、多器官功能障碍综合征(MODS)、舒张压、APACHE II评分、淋巴细胞比值、谷丙转氨酶、降钙素原和碱剩余均与重症患者急性肾功能异常具有相关性。纳入的急性肾功能异常患者中54例(40.9%)死亡。多因素Logistic回归分析结果显示,末梢血氧饱和度(OR=0.966,95%CI[0.953,0.979],P<0.001)、使用机械通气(OR=3.406,95%CI[1.396,8.309],P=0.007)、白细胞计数(OR=1.072,95%CI[1.009,1.139],P=0.025)、乳酸(OR=1.241,95%CI[1.044,1.475],P=0.014)是急性肾功能异常患者28 d病死率的独立危险因素。结论急性肾功能异常是新疆地区重症患者常见的临床综合征,需要各级医院ICU加强对此类患者的识别工作,并针对其发病及不良预后的相关风险因素加强诊疗流程的优化。未来也需要开展针对性的专项培训以推进医疗质量改进,提升本地区重症救治能力。Objective To investigate the incidence of acute renal dysfunction and related factors in critically ill patients in Xinjiang Uygur Autonomous Region of China,in order to provide evidence for targeted special training and quality control in critical care medicine.Methods This was a prospective multicenter cross-sectional survey conducted in Xinjiang Uygur Autonomous Region,China on January 31,2024 and included patients who meet the inclusion criteria.Results A total of 591 patients in 77 ICUs were included in the analysis,including 132 patients(22.3%)with acute renal dysfunction.Multivariate logistic regression analysis showed that age,multiple organ dysfunction syndrome(MODS),diastolic blood pressure,APACHE II score,lymphocyte ratio,alanine aminotransferase,procalcitonin,and base excess were associated with acute renal dysfunction in these patients.Meanwhile,peripheral oxygen saturation(OR=0.966,95%CI[0.953,0.979],P<0.001),mechanical ventilation(OR=3.406,95%CI[1.396,8.309],P=0.007),white blood cell count(OR=1.072,95%CI[1.009,1.139],P=0.025)and lactate(OR=1.241,95%CI[1.044,1.475],P=0.014)were independent risk factors for the 28-day mortality rate in critically ill patients with acute renal dysfunction.Conclusion Acute renal dysfunction is a common clinical syndrome in ICU patients.Clinicians need to strengthen the etiological screening of anemia in these patients and optimize the clinical protocol to improve the quality of intensive care for anemia patients in ICU.It is necessary for the intensivist to strengthen the identification of such patients,and optimize the diagnosis and treatment protocol according to the risk factors related to their morbidity and mortality.It is also necessary to carry out training program to improve the medical quality of critical care medicine in the region.

关 键 词：新疆维吾尔自治区 肾功能异常 横断面调查 病死率 危险因素 

分 类 号：R47[医药卫生—护理学]