急性呼吸窘迫综合征致急性肾损伤危险因素分析

Risk factors of acute kidney injury in patients with acute respiratory distress syndrome

目的分析急性呼吸窘迫综合征(ARDS)患者发生急性肾损伤(AKI)的危险因素。方法回顾性收集2015年8月~2017年12月在我院西区综合ICU病房住院治疗的符合ARDS诊断标准的86例患者,根据改善全球肾脏病预后组织(KDIGO)采用的标准,将符合诊断的患者分为AKI组和非AKI组。结果 AKI组和非AKI组的病死率分别为64.3%和36.2%(P<0.05)。AKI组的基线血肌酐、尿蛋白、C反应蛋白、休克、心力衰竭、静脉应用呋塞米日剂量≥80mg、有创机械通气治疗、应用血液净化治疗比例明显高于非AKI组(P<0.05),而标准氧合指数(Standard Oxygen Index,SOI)、估算肾小球滤过率明显低于非AKI组(P<0.05)。结论 ARDS患者AKI发病率高,且发生AKI后预后不良。ARDS患者发生AKI的危险因素包括基线血肌酐、尿蛋白、C反应蛋白、休克、心力衰竭、SOI、估算肾小球滤过率、静脉应用呋塞米日剂量≥80mg、有创机械通气治疗和应用血液净化治疗。

Objective To explore the risk factors of acute kidney injury（AKI） in patients with acute respiratory distress syndrome（ARDS）. Methods 86 patients with ARDS admitted in the Intensive Care Unit of our hospital from Aug 2015 to Dee 2017 were enrolled for retrospective study. Patients were divided into AKI group and non-AKI group according to Kidney Disease： Improving Global outeomes（KDIGO）criteria. Results The mortality rate of AKI group and non-AKI group was 64.3% and 36.2% respectively（P〈0.05）. Compared with the non-AKI group, baseline serum ereatinine, the proportion of proteinuria, C-reactive protein, the peak level of peep, the daily dose of intravenous furosemide dose ≥80mg and renal replacement therapy in the AKI group was significantly higher. The standard oxygen index（SOI） and the estimated glomerular filtaration rate was significantly lower（P〈0.05）. Conclusion The incidence of AKI in ARDS is high and the prognosis is poor. The baseline serum ereatinine, the proportion of proteinuria, C-reactive protein, shock, heart failure, SOl, the estimated glomerular filtaration rate, the daily dose of intravenous furosemide dose ≥80mg, invasive mechanical ventilation, and renal replacement therapy are the significant risk factors of AKI inpatients with ARDS.