极低出生体重儿急性肾损伤发病的危险因素分析

Risk Factors Analysis of Acute Kidney Injury in Very Low Birth Weight Infants

目的:分析极低出生体重儿急性肾损伤(AKI)发病的临床危险因素,为临床AKI患儿的诊疗方案提供科学根据。方法:收集2019年1月至2021年12月收治的AKI诊断明确且具有完备临床资料的89例极低出生体重儿,设为病例组,并按照1:1配对方法获取未诊断AKI的89例极低出生体重儿,设为对照组,对比两组临床资料,调查分析极低出生体重儿AKI发病的独立危险因素。结果:研究期间共纳入AKI组89例,非AKI组89例。与非AKI组相比,AKI组患儿母孕期合并子痫、肝脏功能损害、妊娠期高血压比例高,病死率高于非AKI组,AKI组患儿发病前患败血症、新生儿坏死性小肠结肠炎发病率高于非AKI组,AKI组患儿需进行有创机械通气、万古霉素治疗比例高于非AKI组(P < 0.05)。多因素logistic回归分析得出,母孕期子痫(OR = 5.522, 95%CI: 1.814~16.814, P = 0.003)、母孕期肝功损害(OR = 5.191, 95%CI: 1.352~19.929, P = 0.016),患儿住院期间合并败血症(OR = 2.935, 95%CI: 1.411~6.103, P = 0.003)、需有创机械通气(OR = 2.972, 95%CI: 1.461~6.046, P = 0.003)是影响极低出生体重儿AKI发病的独立危险因素。结论:母孕期子痫、母孕期肝功损害、败血症、有创机械通气明显增加极低出生体重儿AKI发病的风险。

Objective: To analyze the clinical risk factors of acute kidney injury (AKI) in very low birth weight infants, and to provide scientific basis for the diagnosis and treatment of AKI children. Method: A total of 89 very low birth weight infants with definite diagnosis of AKI and complete clinical data admitted to hospital from January 2019 to December 2021 were selected as the case group, and 89 very low birth weight infants with undiagnosed AKI were selected as the control group according to 1:1 matching method. Clinical data of the two groups were compared. To investigate and analyze the independent risk factors of AKI in very low birth weight infants. Results: A total of 89 cases were in-cluded in the AKI group and 89 cases in the non-AKI group during the study. Compared with the non-AKI group, the AKI group had a higher proportion of pregnant mothers complicated with ec-lampsia, liver function impairment and hypertension during pregnancy, a higher mortality rate than the non-AKI group, and a higher incidence of pre-onset septicemia and neonatal necrotizing enterocolitis than the non-AKI group. The ratio of invasive mechanical ventilation and vancomycin treatment in AKI group was higher than that in non-AKI group (P < 0.05). Multivariate logistic re-gression analysis showed that maternal eclampsia during pregnancy (OR = 5.522, 95%CI: 1.814~16.814, P = 0.003), maternal liver work damage during pregnancy (OR = 5.191, 95%CI: 1.352~19.929, P = 0.016), the patient was complicated with sepsis during hospitalization (OR = 2.935, 95%CI: 1.411~6.103, P = 0.003), and required invasive mechanical ventilation (OR = 2.972, 95%CI: 1.461~6.046, P = 0.003) was an independent risk factor for AKI in very low birth weight in-fants. Conclusions: Maternal eclampsia during pregnancy, maternal liver function impairment dur-ing pregnancy, sepsis and invasive mechanical ventilation significantly increase the risk of AKI in very low birth weight infants.