创伤性脑损伤患者高氯血症与急性肾损伤的关系研究

Relationship between hyperchloremia and acute kidney injury in traumatic brain injury patients

目的 评估经高渗液体疗法干预的创伤性脑损伤(traumatic brain injury, TBI)患者高氯血症与急性肾损伤(acute kidney injury,AKI)的关系。方法 回顾性分析2017年3月至2020年10月台州市中心医院收治的经高渗液体疗法治疗的123例TBI患者资料,按照AKI发生情况,分为AKI组(n=38)和非AKI组(n=85)。从患者病历资料中收集年龄、性别、损伤严重程度评分(injury severity score,ISS)、头部简明损伤定级标准(abbreviated injury scale,AIS)评分、高渗盐水给药持续时间、高氯血症持续时间、最高血清氯化物水平、入院肾小球滤过率(glomerular filtration rate,GFR)、住院时间、重症监护室住院天数、住院死亡率、肾毒性药物使用等资料,分析AKI的发生率,比较两组患者临床特征,采用多因素Logistic回归模型分析发生AKI的独立影响因素。结果 非AKI组患者的入院GFR高于AKI组,高氯血症的持续时间短于AKI组,差异有统计学意义(P<0.05),但输注高渗盐水时间和最高血清氯化物水平比较,差异无统计学意义(P<0.05)。多因素Logistic回归分析显示,入院时GFR[比值比(odds ratio, OR) 0.97, 95%置信区间(confidence interval, CI:0.96~0.99, P=0.004)]和高氯血症持续时间(OR=1.18, 95%CI:1.01~1.39,P=0.014)与AKI的发生呈相关性。入院时GFR和高氯血症持续时间预测发生AKI的临界值分别为80.13ml/(min·1.73m2)和3.02d。结论 TBI患者入院时GFR和高氯血症持续时间与AKI的发生有关,而最高血清氯化物水平和高渗盐水输注时间与AKI的发生无关。

Objective To evaluate the relationship between hyperchloremia and acute kidney injury(AKI) in traumatic brain injury(TBI) patients treated with hypertonic fluid therapy. Methods The data of TBI patients treated with hypertonic fluid therapy in Taizhou Central Hospital from March 2017 to October 2020 were retrospectively analyzed and divided into AKI group(n=38) and non-AKI group(n=85) according to the occurrence of AKI. Date of age, sex, injury severity score(ISS), concise head injury grading standards(AIS) score, hypertonic saline chlorine dosing duration, high disease duration, serum chloride highest level, hospital glomerular filtration rate(GFR), length of hospital stay, ICU hospitalization days, be in hospital mortality, renal toxicity drugs were collected from the medical files. The incidence of AKI was anglicized. Compared the differences in clinical characteristics between the two groups, and multivariate Logistic regression model was used to analyze the independent influencing factors of AKI. Results Patients in the non-AKI group had a higher admission GFR and a shorter duration of hyperchloremia than those in the AKI group, with statistically significant differences(P<0.05). Compared the duration of hypertonic saline infusion and the highest serum chloride level, the differences were not statistically significant(P<0.05).Multifactorial logistic regression analysis showed that GFR at admission [odds ratio(OR) 0.97, 95% confidence interval(CI: 0.96-0.99, P=0.004)] and duration of hyperchloremia(OR=1.18, 95%CI: 1.01-1.39, P=0.014) were correlated with the occurrence of AKI. The cut-off values of GFR and duration of hyperchloremia at admission for predicting AKI were 80.13ml/(min·1.73m~2) and 3.02 days, respectively. Conclusions In patients with TBI, GFR and duration of hyperchloremia at admission were associated with AKI, while the highest serum chloride level and duration of hypertonic saline infusion were not.