急诊抢救室患者发生肾损伤的危险因素

Analysis of the risk factors of kidney injury in patients in the emergency resuscitation room

目的探讨急诊抢救室患者肾损伤的发生情况及危险因素。方法分析2022年2月至2023年2月四川省绵阳市中心医院急诊抢救室收治的266例患者的临床资料,根据进入急诊抢救室48 h是否发生肾损伤将研究对象分为肾损伤组(发生肾损伤,95例)和无肾损伤组(未发生肾损伤,171例)。分析患者进入急诊抢救室48 h的肾损伤发生情况。采用单因素分析和多因素logistic回归方法探讨急诊抢救室患者发生肾损伤的独立危险因素。结果进入急诊抢救室48 h,266例患者中有95例发生肾损伤,肾损伤发生比例为35.71%,其中肾损伤1期46例(48.42%),肾损伤2期29例(30.53%),肾损伤3期20例(21.05%)。单因素分析结果显示,肾损伤组患者年龄>60岁的比例、合并糖尿病比例、合并脓毒症比例、急性生理与慢性健康Ⅱ(APACHEⅡ)评分、血肌酐、应用肾毒性药物比例、应用血管活性药比例、留置导尿管比例均高于无肾损伤组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,年龄>60岁、APACHEⅡ评分升高、血肌酐水平升高、应用肾毒性药物、应用血管活性药物、留置导尿管为急诊抢救室患者发生肾损伤的独立危险因素(P<0.05)。结论急诊抢救室患者的肾损伤发生比例较高,且APACHEⅡ评分升高、血肌酐水平升高、年龄>60岁、应用肾毒性药物、应用血管活性药物、留置导尿管为急诊抢救室患者发生肾损伤的危险因素。

Objective To investigate the occurrence and risk factors of kidney injury in patients in the emergency resuscitation room.Method Clinical data of 266 patients admitted to the emergency resuscitation room of Mianyang Central Hospital of Sichuan Province from February 2022 to February 2023 were retrospectively analyzed.According to whether kidney injury occurred 48 h after entering the emergency resuscitation room,the study subjects were divided into occurrence group(95 cases with kidney injury)and non-occurrence group(171 cases without kidney injury).The occurrence of kidney injury in patients 48 h after entering emergency resuscitation room was analyzed.Univariate and multivariate logistic regression methods were used to analyze the independent risk factors of kidney injury in patients in the emergency resuscitation room.Result 48 h after entering the emergency resuscitation room,95 of 266 patients occurred kidney injury,the incidence of kidney injury was 35.71%,of which 46 patients(48.42%)had kidney injury of stage 1,and 29 patients(30.53%)had kidney injury of stage 2,and 20 patients(21.05%)had kidney injury of stage 3.The results of unifactorial analysis showed that the proportion of patients with age>60 years old,the proportion of patients with diabetes mellitus,the proportion of patients with sepsis,the APACHEⅡscore,serum creatinine,the proportion of nephrotoxic drugs,the proportion of vasoactive drugs,and the proportion of indentured catheters were higher than those in the non-occurrence group,and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that age>60 years old,increased APACHEⅡscore,increased serum creatinine level,application of nephrotoxic drugs,application of vasoactive drugs,indentured catheters were independent risk factors for kidney injury in emergency resuscitation room patients(P<0.05).Conclusion The incidence of kidney injury was higher in emergency resuscitation room patients,and the independent risk factors for kidney injury were increased APACHEⅡscore,increased serum creatinine level,age>60 years old,application of nephrotoxic drugs,application of vasoactive drugs,indentured catheters.