早产儿急性肾损伤发生情况及相关危险因素分析
发布时间：2018-12-18 13:39
【摘要】：目的:调查早产儿急性肾损伤(AKI)的发生情况和临床特点,分析AKI的相关危险因素。方法:本项目为回顾性研究,以2013年1月至2015年6月入住蚌埠医学院第一附属医院儿科新生儿重症监护室的早产儿为研究对象,病人来源为皖北地区。早产儿AKI定义:不论日龄和尿量,血清肌酐值(SCr)1.5 mg/dl(133μmol/L)。检索电子病历系统,病例纳入标准:出生胎龄37周,入院日龄1 d。病例排除标准:资料不完整,先天性泌尿系统畸形,母亲有肾衰竭史,生后48小时内死亡或转出至其他医院的患儿。将住院过程中发生AKI的早产儿设定为病例组,同期住院过程中未发生AKI的早产儿设为对照组。收集资料如下:患儿一般情况如性别、胎龄、出生体重,妊娠史,患儿围生期情况,发生AKI之前的基础疾病,实验室资料,以及住院时间等。采用单因素分析及二分类Logistic回归模型进行数据分析,筛选出AKI相关危险因素。结果:共收集早产儿750例,平均胎龄为(34.14±1.98)周,平均出生体重(2146.91±492.20)克。AKI组263例,占总数的35.07%,非AKI组487例,占总数的64.93%;AKI组中,男性166例,占本组的63.12%,女性97例,占本组的36.88%,男女比例为1.71:1;非AKI组中,男性301例,占本组的61.81%,女性186例,占本组的38.19%,男女比例为1.62:1。单因素分析表明2组早产儿在出生体重、胎龄、胎盘早剥、妊娠期高血压疾病、Apgar 1分钟评分、Apgar5分钟评分、生后1周内发热、机械通气、输血治疗、新生儿呼吸窘迫综合征、败血症、新生儿感染、代谢性酸中毒、CRP、PCT方面差异有统计学意义。二分类Logistic回归分析表明妊娠期高血压疾病(OR=1.573,95%CI 1.080~2.290),生后1周内发热(OR=2.049,95%CI 1.457~2.881)、新生儿呼吸窘迫综合征(OR=1.674,95%CI 1.135~2.469)、代谢性酸中毒(OR=2.351,95%CI1.103~5.012)、输血(OR=9.202,95%CI 4.224~20.050)、胎龄34周(OR=1.636,95%CI 1.132~2.364)与早产儿AKI显著相关。结论:早产儿AKI发生率为35.07%。妊娠期高血压疾病、生后1周内发热、新生儿呼吸窘迫综合征、代谢性酸中毒、输血治疗、胎龄34周是早产儿AKI的独立危险因素。加强妊娠期和新生儿期管理,有望降低早产儿AKI的发生率。
[Abstract]:Objective: to investigate the incidence and clinical characteristics of (AKI) in premature infants with acute renal injury and to analyze the risk factors of AKI. Methods: a retrospective study was conducted on premature infants admitted to the Pediatric Neonatal intensive Care Unit of the first affiliated Hospital of Bengbu Medical College from January 2013 to June 2015. AKI definition: serum creatinine (SCr) 1. 5 mg/dl (133 渭 mol/L) regardless of age and urine volume. The electronic medical record system was searched. The inclusion criteria were 37 weeks of gestational age and 1 day of admission. Exclusion criteria: incomplete data, congenital urinary system malformations, mothers with a history of renal failure, and children who died or were transferred to other hospitals within 48 hours of birth. Premature infants with AKI during hospitalization were selected as case group, and premature infants without AKI during hospitalization were set as control group. The data were as follows: sex, gestational age, birth weight, pregnancy history, perinatal period, basic diseases before AKI, laboratory data and hospital stay. Single factor analysis and two classification Logistic regression model were used to analyze the data and the risk factors related to AKI were screened out. Results: a total of 750 premature infants were collected. The average gestational age was (34.14 卤1.98) weeks, and the average birth weight was (2146.91 卤492.20) g. There were 263 cases in AKI group (35.07%) and 487 cases in non-AKI group (64.93%). In the AKI group, there were 166 males (63.12%) and 97 females (36.88%). The ratio of male to female was 1.71: 1; In the non-AKI group, there were 301 males (61.81%) and 186 females (38.19%). The ratio of male to female was 1.62: 1. Univariate analysis showed that the birth weight, gestational age, placental abruption, hypertensive disorder complicating pregnancy, Apgar 1 minute score, Apgar5 minute score, fever, mechanical ventilation, blood transfusion therapy, neonatal respiratory distress syndrome (RDS) were measured in the two groups. Septicemia, neonatal infection, metabolic acidosis, CRP,PCT differences were statistically significant. Two classification Logistic regression analysis showed that hypertensive disorder complicating pregnancy (OR=1.573,95%CI 1.080 卤2.290), fever within one week (OR=2.049,95%CI 1.457 卤2.881), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), and neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135, 2.469). Metabolic acidosis (OR=2.351,95%CI1.103~5.012), blood transfusion (OR=9.202,95%CI 4.224) and gestational age of 34 weeks (OR=1.636,95%CI 1.132 卤2.364) were significantly associated with AKI in premature infants. Conclusion: the incidence of AKI in premature infants is 35.07. Hypertensive disorder complicating pregnancy, fever within 1 week after birth, neonatal respiratory distress syndrome, metabolic acidosis, transfusion therapy and gestational age of 34 weeks were independent risk factors for AKI of premature infants. Strengthening the management of gestation and newborn is expected to reduce the incidence of AKI in preterm infants.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6
本文编号：2385929
[Abstract]:Objective: to investigate the incidence and clinical characteristics of (AKI) in premature infants with acute renal injury and to analyze the risk factors of AKI. Methods: a retrospective study was conducted on premature infants admitted to the Pediatric Neonatal intensive Care Unit of the first affiliated Hospital of Bengbu Medical College from January 2013 to June 2015. AKI definition: serum creatinine (SCr) 1. 5 mg/dl (133 渭 mol/L) regardless of age and urine volume. The electronic medical record system was searched. The inclusion criteria were 37 weeks of gestational age and 1 day of admission. Exclusion criteria: incomplete data, congenital urinary system malformations, mothers with a history of renal failure, and children who died or were transferred to other hospitals within 48 hours of birth. Premature infants with AKI during hospitalization were selected as case group, and premature infants without AKI during hospitalization were set as control group. The data were as follows: sex, gestational age, birth weight, pregnancy history, perinatal period, basic diseases before AKI, laboratory data and hospital stay. Single factor analysis and two classification Logistic regression model were used to analyze the data and the risk factors related to AKI were screened out. Results: a total of 750 premature infants were collected. The average gestational age was (34.14 卤1.98) weeks, and the average birth weight was (2146.91 卤492.20) g. There were 263 cases in AKI group (35.07%) and 487 cases in non-AKI group (64.93%). In the AKI group, there were 166 males (63.12%) and 97 females (36.88%). The ratio of male to female was 1.71: 1; In the non-AKI group, there were 301 males (61.81%) and 186 females (38.19%). The ratio of male to female was 1.62: 1. Univariate analysis showed that the birth weight, gestational age, placental abruption, hypertensive disorder complicating pregnancy, Apgar 1 minute score, Apgar5 minute score, fever, mechanical ventilation, blood transfusion therapy, neonatal respiratory distress syndrome (RDS) were measured in the two groups. Septicemia, neonatal infection, metabolic acidosis, CRP,PCT differences were statistically significant. Two classification Logistic regression analysis showed that hypertensive disorder complicating pregnancy (OR=1.573,95%CI 1.080 卤2.290), fever within one week (OR=2.049,95%CI 1.457 卤2.881), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135), and neonatal respiratory distress syndrome (OR=1.674,95%CI 1.135, 2.469). Metabolic acidosis (OR=2.351,95%CI1.103~5.012), blood transfusion (OR=9.202,95%CI 4.224) and gestational age of 34 weeks (OR=1.636,95%CI 1.132 卤2.364) were significantly associated with AKI in premature infants. Conclusion: the incidence of AKI in premature infants is 35.07. Hypertensive disorder complicating pregnancy, fever within 1 week after birth, neonatal respiratory distress syndrome, metabolic acidosis, transfusion therapy and gestational age of 34 weeks were independent risk factors for AKI of premature infants. Strengthening the management of gestation and newborn is expected to reduce the incidence of AKI in preterm infants.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6
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