肠梗阻患者并发急性肾损伤的临床特点及影响因素分析

Analysis of clinical characteristics and influencing factors of acute kidney injury in patients with intestinal obstruction

目的观察肠梗阻患者并发急性肾损伤(acute kidney injury,AKI)的临床特点并分析其相关影响因素。方法回顾性分析2017年1月至2019年12月武汉大学人民医院收治的63例肠梗阻并发AKI患者的临床资料,并将其作为A组,再随机选取肠梗阻未发生肾功能损伤的63例患者作为B组;分析患者的基线资料,如年龄、性别、相关血清指标、合并疾病等。比较两组患者上述资料的差异,对可能导致患者发生AKI的因素进行分析,并经多因素Logistic回归分析找出导致可能影响肠梗阻发生AKI的危险因素。结果两组患者在性别、是否复发、腹盆部手术史、糖尿病、浆膜腔积液、肾结石的患病率对比,差异无统计学意义(P>0.05);A组患者在年龄、发病时间、住院时间、血尿素氮、血尿酸、合并高血压、心血管疾病、感染的比例显著高于B组,差异有统计学意义(P<0.05);通过Logistic回归分析显示,年龄≥65岁(OR=10.140,95%CI:3.197~32.164,P=0.000)、合并高血压(OR=3.682,95%CI:1.128~12.02,P=0.031)、血尿酸升高(OR=1.008,95%CI:1.002~1.015,P=0.008)可能是影响肠梗阻发生AKI的危险因素。结论高龄、高血尿酸、合并高血压可能是肠梗阻并发AKI的危险因素,对于伴发相关风险因素的老年肠梗阻患者,临床上应早期识别并实施干预措施,以降低AKI的发生率,进一步减少预后不良风险的发生。

Objective To observe the clinical characteristics of acute kidney injury(AKI)in patients with intestinal obstruction and analyze its related influencing factors.Methods The clinical data of 63 paitients with intestinal obstruction complicated with AKI admitted to Renmin Hospital of Wuhan University from Jan.2017 to Dec.2019 were retrospectively analyzed,and treated as group A.Then 63 patients with intestinal obstruction without kidney insufficiency were randomly selected as group B.Baseline data,such as age,sex,related serum indicators and concomitant disease were analyzed.The differences of the above data between the two groups of patients were compared,and the risk factors that may lead to the occurrence of AKI in intestinal obstruction were found out by multivariate Logistic regression analysis.Results There were no statistically significant differences between the two groups in terms of gender,recurrence,pelvic surgery history,diabetes,atrial fibrillation,serous cavity effusion and kidney stones(P<0.05).The age,onset time,length of hospital stay,blood urea nitrogen,blood uric acid,hypertension,cardiovascular disease and infection in group A were significantly higher than those in group B,with statistically significant differences(P<0.05).Logistic regression analysis showed that age≥65 years old(OR=10.140,95%CI:3.197~32.164,P=0.000),complicated hypertension(OR=3.682,95%CI:1.128~12.02,P=0.031)and high blood uric acid(OR=1.008,95%CI:1.002~1.015,P=0.008)may be risk factors for AKI by intestinal obstruction.Conclusion Advanced age,high blood uric acid and hypertension may be risk factors for intestinal obstruction complicated with AKI.For elderly patients with intestinal obstruction accompanied by related risk factors,early identification and intervention measures should be implemented clinically to reduce the incidence of AKI further reduce the risk of poor prognosis.