上尿路梗阻致急性肾损伤的病因分析及其预后危险因素研究

发布时间：2018-03-16 02:30

本文选题：急性肾损伤　切入点：病因　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨上尿路梗阻致急性肾损伤的病因以及分析影响肾功能恢复的相关性因素,为临床更好地预防急性肾损伤、改善患者的预后提供依据。方法:回顾性分析2012年1月至2016年12月期间在广西医科大学第一附属医院泌尿外科住院治疗的患者的临床资料,按照纳入与排除标准,筛选出病史完整的118例AKI患者,记录患者基本情况、相关检查、治疗方式、预后等临床资料。以患者术后1月作为截止点,根据AKI患者肾功能恢复情况,将AKI患者预后分为肾脏治愈组,部分愈合组及愈合不良组组三组。用SPSS16.0统计学软件统计分析AKI患者预后的独立危险因素。运用了χ2检验、独立样本t检验、单因素方差分析以及多元Logistic回归分析统计分析方法。结果:观察118例上尿路梗阻致急性肾损伤的病因中,上尿路结石是最常见的病因,占88.14%,肿瘤转移或者压迫,占7.63%,其他导致急性肾损伤占4.24%,比如输尿管炎性狭窄、移植肾输尿管下端狭窄并积水等。其中上尿路结石所致急性肾损伤患者的病因中,孤立肾输尿管结石占52.88%(55/104);双侧输尿管结石占34.62%(36/104);单侧输尿管结石合并另一侧肾结石4.8%(5/104);一侧输尿管结石7.69%(8/104)。独立样本t检验分析肾功能恢复与患者年龄、血钾浓度(K+)、血红蛋白(Hb)等一般临床资料无关,单因素卡方检验分析提示术后是否出现多尿期、AKI分期以及RRT与肾脏预后差异有统计学意义,但经多因素校正后仅临床分期以及RRT肾脏预后差异有统计学意义。结论:本组资料中急性肾损伤的主要病因为上尿路结石、其次为肿瘤;AKI临床分期为急性肾损伤患者预后不良的危险因素,RRT是上尿路梗阻性急性肾损伤的保护因素。
[Abstract]:Objective: to investigate the etiology of acute renal injury caused by upper urinary tract obstruction and to analyze the related factors affecting the recovery of renal function in order to prevent acute renal injury in clinic. Methods: the clinical data of patients hospitalized in Urology Department of the first affiliated Hospital of Guangxi Medical University from January 2012 to December 2016 were analyzed retrospectively. A total of 118 patients with AKI with complete history were selected to record the basic information, relevant examinations, treatment methods, prognosis and other clinical data. Taking January as the cut-off point, according to the recovery of renal function in patients with AKI, The prognosis of AKI patients was divided into three groups: kidney healing group, partial healing group and poor healing group. The independent risk factors of prognosis of AKI patients were statistically analyzed by SPSS16.0 statistical software. 蠂 2 test and independent sample t test were used. Results: among 118 cases of acute renal injury caused by upper urinary tract obstruction, upper urinary tract stone was the most common cause, accounting for 88.14%, tumor metastasis or compression. Other causes of acute renal injury, such as ureteral inflammatory stenosis, renal graft ureteral stenosis and hydronephrosis, were among the causes of acute renal injury caused by upper urinary calculi. Isolated renal ureterolithiasis accounted for 52.88 / 104%; bilateral ureteral calculi accounted for 34.62% 36 / 104%; unilateral ureterolithiasis combined with another side of renal calculi 4.8 / 104; side ureteral stones 7.69% / 104; independent sample t test analysis of renal function recovery and patient age. There was no significant difference in clinical data, such as serum potassium concentration and hemoglobin (HB). Univariate chi-square test showed that there were significant differences in the stage of polyuria and the prognosis between RRT and kidney. But only clinical stage and renal prognosis of RRT were significantly different after multivariate correction. Conclusion: the main cause of acute renal injury in this group is upper urinary calculi. The clinical stage of AKI was the risk factor of poor prognosis in patients with acute renal injury. RRT was the protective factor of acute renal injury caused by upper urinary tract obstruction.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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