有创通气的急性呼吸窘迫患者发生急性肾损伤的危险因素分析

Analysis of risk factors of acute kidney injury in acute respiratory distress syndrome patients with mechanical ventilation

目的探讨有创机械通气的急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者发生急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析2019年01月至2019年12月泰州市人民医院重症医学科收治的有创机械通气的ARDS患者的临床资料,根据患者是否发生AKI,分为AKI组和非AKI组。比较两组患者的临床特征和实验室指标;分析影响有创机械通气的ARDS患者发生AKI的危险因素;绘制Kaplan-Meier生存曲线,比较两组患者的生存率。结果共120名有创机械通气的ARDS患者,其中57名发生AKI,发生率为47.5%。降钙素原、基础肌酐增高,pH值降低和意识障碍是有创机械通气的ARDS患者发生AKI的独立危险因素。120例患者中57名死亡,总住院病死率38.3%。Kaplan-Meier生存曲线表明,AKI组生存率低于非AKI组,差异有统计学意义(P<0.001)。结论有创机械通气的ARDS患者AKI发生率高,可明显增加患者住院病死率。降钙素原、基础肌酐增高,pH值降低和意识障碍是有创机械通气的ARDS患者发生AKI的独立危险因素。

Objective To explore the risk factors of acute kidney injury(AKI)in acute respiratory distress syndrome(ARDS)patients with mechanical ventilation.Methods A retrospective analysis was conducted.ARDS patients with mechanical ventilation admitted to ICU of Taizhou People's Hospital from January 2019 to December 2019 were enrolled.Patients were divided into the AKI group and non-AKI group according to whether the patients had AKI.Clinical characteristics and laboratory indicators of the two groups were compared.Risk factors of incidence of AKI in ARDS patients were analyzed.The Kaplan-Meier survival curve was drawn to evaluate the survival rates of the two groups.Results A total of 120 ARDS patients with mechanical ventilation were included,and 57 patients(47.5%)developed AKI.Procalcitonin,increased basal creatinine,decreased pH and impaired consciousness were independent risk factors for AKI in ARDS patients with mechanical ventilation.Fifty-seven of the 120 patients died with a mortality of 38.3%.The Kaplan-Meier survival curve showed that the survival rate of the AKI group was significantly lower than that of the non-AKI group(P<0.001).Conclusions The incidence and mortality of AKI is high in ARDS patients with mechanical ventilation.Procalcitonin,increased basal creatinine,decreased pH and impaired consciousness are independent risk factors for AKI in ARDS patients with mechanical ventilation.