危重患者急性肾损伤危险因素分析

Analysis of risk factors in severe patients with acute kidney injury

目的研究外科重症监护室及综合性重症监护室危重患者发生急性肾损伤(AKI)的危险因素。方法回顾性分析四川大学华西医院外科及综合性重症监护病房2009年10月至12月所有的住院患者,筛选资料完整且符合标准的病例共273例,分别进行单因素和多因素分析。结果外科及综合性重症监护室危重患者AKI发生率为27.1%,病死率45.2%。AKI的独立危险因素为糖尿病(X1)(P=0.006)、慢性肝病(X2)(P=0.047)、非手术治疗(X3)(P=0.013)、基础肌酐值>120μmol/L(X4)(P=0.006)、脓毒血症(X5)(P<0.001)、肾毒性药物应用(X6)(P=0.004)。Logistic回归模型:Logistic P=-3.556+1.132X1+1.121X2-0.884X3+0.980X4+1.645X5+2.246X6。结论外科及综合性重症监护室危重患者一旦发生AKI,其病死率明显增加,外科及综合性重症监护室发生AKI的主要危险因素为糖尿病、有慢性肝病、脓毒血症,基础肌酐值>120μmol/L及肾毒性药物应用者。手术治疗为AKI保护因素。

Objective To investigate the risk factors to cause acute kidney injury（AKI） in severe patients in surgical ICU and general ICU. Methods Between October 2009 and December 2009, a .total of 273 patients admitted in surgical ICU and general ICU who had integrated datas and met the standards were selected and retrospectively analyzed for single factor and muti-factor analysis,respectively. Results The AKI occurrence rate was 27.1% and mortality rate 45.2% among severe patients in surgical ICU and general ICU. The independent risk factors of AKI include diabetes （Xt ） （P = 0. 006 ）, Chronic Liver Disease （ X2 ） （ P = 0. 047）, Non-surgery （ X3 ） （ P = 0. 013 ）, Scr 〉 120 （ X4 ） μmol/L, Sepsis （ X5 ） （ P 〈 0. 001 ） and Nephrotoxic agents applying（X6 ） （P =-0. 004）. The multivariate logistic regression model was：Logistic P = - 3. 556 ＋ 1. 132X1 ＋ 1. 121X2 -0. 884X3 ＋0. 980X4 ＋ 1. 645X5 ＋2. 246X6. Conclusion Once AKI occurs among severe patients in surgical ICU and general ICU, the mortality rate can be significantly increased. Tile risk factors of AKI are mainly diabe- tes, chronic liver disease, non-surgery, scr 〉 120 μmol/L, sepsis and nephrotoxic agents applying. Surgical treatment may be a protective factor of AKI.