ICU与非ICU的AKI患者临床特征及预后危险因素的比较

发布时间：2018-01-30 00:29

本文关键词： 重症监护室急性肾损伤 AKIN诊断标准危险因素预后　出处：《福建医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：比较重症监护室(ICU)与非ICU的AKI患者临床特征及其预后相关危险因素。方法：回顾性分析福建医科大学附属第一医院2011年期间符合AKIN诊断标准的703例住院的AKI患者的临床资料，按是否进入重症监护室分为ICU组与非ICU组，对比其临床特征，并用多因素Logistic回归分析其预后危险因素。结果： 1、703例AKI患者，非ICU组486例，ICU组217例。与非ICU组比较，ICU组患者AKI分期更差：1期(35.0%vs57.8%，P0.001)，2期(21.2%vs15.8%，，P=0.084)，3期(43.8%vs26.4%，P0.001)，肾功能丢失率更高(56.7%vs21.5%，P0.001)，病死率也更高(53.9%vs10.7%，P0.001)。 2、ICU组与非ICU组引起AKI的病因均以肾前性为主(73.3%vs60.0%，P0.001)，ICU组的肾脏替代治疗率(25.8%vs7.4%，P0.001)、机械通气使用率(71.9%vs2.9%，P0.001)、升压药的使用率(61.8%vs11.1%，P0.001)均明显高于非ICU组。 3、ICU组引起肾功能丢失的危险因素有APACHII评分(P0.001，OR值=1.181)、机械通气(P=0.001，OR值=4.187)、少尿史(P=0.015，OR值=2.981)、低血压史(P=0.001，OR值=3.422)、凝血异常(P=0.021，OR值=3.455)；而非ICU组为AKI分期(P0.001，OR值=3.187)、高血压病(P=0.035，OR值=1.984)、恶性肿瘤史(P=0.001，OR值=3.225)、慢性肾脏病(P=0.018，OR值=2.131)、利尿剂(P=0.004，OR值=2.437)、低血压(P0.001，OR值=10.152)、肾外器官衰竭数(P=0.001，OR值=2.055)。 4、ICU组引起患者死亡的危险因素有APACHII评分(P0.001，OR值=1.289)、机械通气(P=0.006，OR值=4.241)、低血压史(P0.001，OR值=17.308)、脓毒症(P=0.027，OR值=4.050)；而非ICU组为恶性肿瘤(P=0.005，OR值=3.513)、低血压史(P0.001，OR值=34.724)、RRT治疗(P=0.038，OR值=3.058)、利尿剂(P=0.011，OR值=3.673)、肾外器官衰竭数(P0.001，OR值=2.737)。结论： 1、ICU的AKI病人有更高的肾功能丢失率及病死率，其肾脏替代治疗、机械通气及升压药的使用率均明显增高。 2、低血压是ICU及非ICU的AKI病人的肾脏丢失和死亡的共同危险因素。 3、APACH II评分和机械通气是ICU的AKI病人肾脏丢失和死亡的独立危险因素，而合并基础疾病、肾外器官衰竭及利尿剂的使用则是ICU的AKI病人肾脏丢失和死亡的独立危险因素。
[Abstract]:Objective: to compare the clinical features and prognostic risk factors between ICU and non-ICU patients with AKI. Methods: the clinical data of 703 AKI patients who met the diagnostic criteria of AKIN in the first affiliated Hospital of Fujian Medical University in 2011 were analyzed retrospectively. The patients were divided into ICU group and non ICU group according to whether they entered intensive care unit. The clinical characteristics were compared and the prognostic risk factors were analyzed by multivariate Logistic regression analysis. Results: 1,703 cases of AKI and 1,703 cases of non-#en1# group were compared with non-#en2# group. In the ICU group, the AKI stage was worse than that in the first stage (35.0 vs 57.8), and the P0.001 stage was 21.2Vs15.8VS 0.084). In phase 3, Vs26.4 and P0.001, the loss rate of renal function was higher than that of 56.7 vs21.5P0.001). The mortality rate was also higher than 53.9% vs 10.7% P 0.001. 2the etiology of AKI in ICU group and non ICU group was mainly prerenal (73.3% vs 60.0% P 0.001). The rate of renal replacement therapy in ICU group was 25. 8% vs 7. 4%, and the rate of mechanical ventilation was 71.9 vs 2. 9% P0.001). The utilization rate of blood pressure booster drug was significantly higher than that of non-ICU group (61.8 vs 11. 1 and P 0. 001). 3The risk factors of renal function loss in ICU group were APACHII score (P 0.001) OR value (1.181) and mechanical ventilation (P < 0.001). The OR value was 4.187m, the OR value of oliguria was 2.981, and the OR value of hypotension was 3.422). The OR value of P0. 021 was 3.455g; In the non-#en0# group, AKI stage (P 0.001) OR value was 3.1871, hypertension patient (P < 0.035) OR value was 1.984g, malignant tumor history was P0. 001. The OR value was 3.225, the OR value of chronic kidney disease was 2.131, the OR value of diuretic P0. 004 was 2.437g, the hypotension was P0.001. The OR value was 10.152%, and the OR value was 2.055% (P < 0.001). 4 the risk factors of death in ICU group were APACHII score (P 0.001) OR value (1.289), mechanical ventilation (P < 0.006). The OR value was 4.241, P 0.001 or was 17.308, and the OR value of sepsis was 4.050. In the non-#en0# group, the OR value of malignant tumor was 3.513, and the OR value of P 0.001 or was 34.724% in the patients with hypotension (P = 0.038, P = 0.038, P = 0.038, P = 0. 038, P = 0. 038, P = 0. 038). The OR value was 3.058, the OR value of diuretic was 0.011 and the OR value was 3.673, and the OR value of P0.001 was 2.737. Conclusion: 1in AKI patients, the rate of renal function loss and mortality was higher, and the utilization rate of renal replacement therapy, mechanical ventilation and blood pressure booster were significantly increased. 2. Hypotension is a common risk factor for kidney loss and death in ICU and non-ICU AKI patients. 3APACH II score and mechanical ventilation were independent risk factors for kidney loss and death in AKI patients with ICU, and were associated with underlying diseases. Extrarenal organ failure and diuretic use were independent risk factors for kidney loss and death in AKI patients with ICU.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

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