重症监护病房外科术后急性肾损伤的危险因素及其预后

RISK FACTORS AND PROGNOSIS OF ACUTE RENAL INJURY AFTER SURGERY IN ICU

目的寻找重症监护病房(ICU)外科手术后急性肾损伤(AKI)的危险因素并评价。方法回顾性分析了唐山市人民医院重症医学科2017年1月1日—2017年12月31日927例外科手术患者的临床数据,采用2012年改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)诊断标准对AKI进行定义和分期。通过回归分析进行危险因素变量的筛选。结果手术后AKI发病率40.3%,对手术后AKI组患者374例进行分期(Ⅰ期202例,Ⅱ期69例,Ⅲ期103例),各分期所占的比例分别为54.0%、18.4%、27.6%。通过多因素Logistic回归分析显示:糖尿病、急性生理和慢性健康状况评分(APACHE)Ⅱ评分、序贯器官衰竭评分(SOFA)、液体正平衡天数、血管活性药、利尿剂、脓毒症(sepsis)、颅脑手术是重症监护病房外科术后AKI发生的独立危险因素。结论ICU外科术后AKI的发病率较高,8个术后AKI发生的独立危险因素被确立,AKI的发生是术后死亡的重要因素。

Objective To identify and evaluate the risk factors for acute kidney injury(AKI)after surgery in the intensive care unit(ICU).Methods The clinical data of nine hundred and twenty-seven patients undergoing surgery from January 1,2017 to December 31,2017 in the Department of Critical Care Medicine of Tangshan People’s Hospital were retrospectively analyzed.AKI was defined and staged using the diagnostic criteria of 2012(KDIGO).The risk factors were selected by regression analysis.Results The incidence of AKI was 40.3%after operation,and 374 cases of AKI in the operation group were staged(202 cases in stageⅠ,69 cases in stageⅡ,and 103 cases in stageⅢ).The proportion of each stage was 54.0%,18.4%,27.6%.Logistic regression analysis showed:diabetes,acute physiology and chronic health status score(APACHE)Ⅱscore,sequential organ failure score(SOFA),liquid positive balance days,diuretics,sepsis(sepsis)and craniocerebral surgery were independent risk factors for AKI after surgery in intensive care unit.Conclusion The incidence of AKI is high in ICU after surgery.Eight independent risk factors for postoperative AKI are established.The occurrence of AKI is an important factor in postoperative death.