高血压合并急性出血性脑卒中院内死亡相关风险研究

发布时间：2019-03-23 15:13

【摘要】：目的：评估急性肾损伤对高血压合并出血性脑卒中患者近期预后的影响。方法：收集2005年1月1日至2012年6月1日在太原市中心医院诊治且病历资料、影像学资料完整的全部脑出血患者，共806例，全部于发病后24h内经头颅CT证实脑出血，均符合《中国脑血管病防治指南》关于脑出血的诊断标准。下列病例排除在本研宄之外；未经头颅CT及MRI诊断者；瘤卒中等继发脑出血者；脑外伤导致出血者既往合并慢性肾脏病史者；病史及诊断不明确者。急性肾损伤定义为7天内最高肌酐水平较入院时升高50%。病人根据入院期间肾小球滤过率以及是否发生急性肾损伤分为4个亚组：eGFR90不合并急性肾损伤，eGFR90不合并急性肾损伤，eGFR90合并急性肾损伤，以及eGFR90合并急性肾损伤。结果：本研宄中16.7%的病人发生了急性肾损伤。入院时的肾小球滤过率不是预测患者近期发生死亡的独立危险因素。但是，急性肾损伤与患者近期预后明显相关。各亚组30天内发生死亡的住院患者通过调整后的风险比率（AHR，Cox多元回归分析）进行组间比较。eGFR90不伴急性肾损伤AHR1.0(95%CI0.42-1.82)，eGFR90不伴急性肾损伤AHR1.18(95%CI0.79-1.76)，eGFR90伴急性肾损伤AHR1.70(95%CI1.09-2.63)，eGFR90伴急性肾损伤AHR1.86(95%CI1.09-3.17). 结论：无论入院时eGFR是否降低，急性肾损伤均是患者住院期间近期发生死亡的独立危险因素.
[Abstract]:Objective: to evaluate the effect of acute renal injury on short-term prognosis of hypertensive patients with hemorrhagic stroke. Methods: medical records were collected from January 1, 2005 to June 1, 2012 in Taiyuan Central Hospital. All the 806 patients with cerebral hemorrhage with complete imaging data were confirmed by head CT within 24 hours after onset. All of them accord with the diagnostic criteria of cerebral hemorrhage in China guidelines for the Prevention and treatment of Cerebrovascular Diseases. The following cases were excluded from the study: those who had not been diagnosed by CT and MRI of the head; those with secondary intracerebral hemorrhage in the middle of the tumor stroke; those with previous chronic renal history of hemorrhage caused by brain trauma; and those whose history and diagnosis were not clear. Acute renal injury is defined as a 50% increase in creatinine within 7 days from admission. The patients were divided into 4 subgroups according to glomerular filtration rate (GFR) and acute renal injury during admission: eGFR90 without acute renal injury, eGFR90 with acute renal injury, and eGFR90 with acute renal injury. Results: acute renal injury occurred in 16.7% of the patients. Glomerular filtration rate at admission is not an independent risk factor for short-term death. However, acute renal injury was significantly associated with short-term prognosis. Patients who died within 30 days in each subgroup were compared by adjusted risk ratio (AHR,Cox multiple regression analysis). EGFR90 was not associated with acute renal injury (AHR1.0 (95%CI0.42-1.82). EGFR90 without acute renal injury AHR1.18 (95%CI0.79-1.76), eGFR90 with acute renal injury AHR1.70 (95%CI1.09-2.63), eGFR90 with acute renal injury AHR1.86 (95%CI1.09-3.17). Conclusion: acute renal injury is an independent risk factor for short-term death in patients with acute renal injury, regardless of the decrease of eGFR at admission.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R544.1;R743.3

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