重度颅脑外伤患者颅内血肿清除术后急性肾功能不全的危险因素分析

Risk factors of acute renal insufficiency after removal of intracranial hematoma in patients with severe craniocerebral trauma

目的探讨重度颅脑外伤患者颅内血肿清除术后出现急性肾功能不全的危险因素及相关预防措施,为重度颅脑外伤患者的临床治疗提供参考。方法选择2015年5月—2018年6月新疆维吾尔自治区人民医院神经外科收治的行颅内血肿清除术的重度颅脑外伤患者266例作为研究对象,根据患者术后是否并发急性肾功能不全,将其分为对照组(非急性肾功能不全)216例和观察组(急性肾功能不全)50例2组,通过单因素Logistic分析患者术后出现急性肾功能不全的影响因素,多因素Logistic分析患者术后出现急性肾功能不全的独立危险因素,并对其独立危险因素的预测价值进行分析。结果经单因素分析,重度颅脑外伤患者颅内血肿清除术后出现急性肾功能不全的影响因素有性别、年龄、血浆凝血酶时间、低血压、格拉斯哥昏迷评分(GCS)以及甘露醇治疗;再经多因素Logistic分析显示性别、年龄、低血压、甘露醇治疗及GCS评分是颅内血肿清除术后出现急性肾功能不全的独立危险因素(P<0.05)。GCS评分的ROC曲线下面积(AUC)最大。结论性别、年龄、低血压、甘露醇治疗以及GCS评分是重度颅脑外伤患者颅内血肿清除术后出现急性肾功能不全的独立危险因素。术后应根据患者情况进行营养、脱水剂以及护肾治疗,改善交感神经兴奋状态,减轻肾功能的损伤。

Objective To explore the risk factors and preventive measures of acute renal insufficiency in patients with severe craniocerebral trauma after removal of intracranial hematoma,so as to provide reference for clinical treatment of patients with severe craniocerebral trauma.Methods From May 2015 to June 2018,266 patients with severe craniocerebral trauma treated by neurosurgery in Xinjiang Uygur Autonomous Region People's Hospital were selected as the study subjects.According to whether the patients were complicated with acute renal insufficiency after operation,the patients were divided into control group(216 cases of non-acute renal insufficiency)and observation group(acute renal insufficiency of 50 cases).Univariate Logistic analysis was used to analyze the influencing factors of acute renal insufficiency after operation,and multivariate Logistic analysis was used to analyze the independent risk factors of acute renal insufficiency after operation,and to analyze the predictive value of the independent risk factors.Results After single factor analysis,the factors affecting acute renal insufficiency after intracranial hematoma evacuation in patients with severe craniocerebral trauma were gender,age,plasma thrombin time,hypotension,Glasgow Coma Scale(GCS)and mannitol treatment;Multivariate logistic analysis showed that gender,age,hypotension,mannitol treatment and GCS score were independent risk factors for acute renal insufficiency after intracranial hematoma evacuation(P<0.05).The area under the ROC curve(AUC)of the GCS score is the largest.Conclusion Gender,age,hypotension,mannitol therapy and GCS score were independent risk factors for acute renal insufficiency after removal of intracranial hematoma in patients with severe craniocerebral trauma.Nutrition,dehydration and kidney protection should be given according to the patient's condition after operation to improve sympathetic nerve excitation and alleviate the damage of renal function.