高龄老年人急性肾损伤危险因素及短期预后的研究
发布时间：2019-07-09 16:32
【摘要】：第一部分 老年急性肾损伤短期预后及危险因素的分析 目的对老年急性肾损伤(AKI)患者进行随访观察，分析AKI的短期预后及危险因素。 方法选择2008年1月-2009年12月就诊于解放军总医院老年病房的232例AKI患者为研究对象，根据发生AKI后至28d时段和29d至3个月时段患者的生存情况，将患者病历资料分成死亡组和存活组进行分析，采用t检验或Pearson X2检验筛查出影响预后的因素，将有统计学意义的因素为自变量进行多因素Logistic回归分析，判断各因素对死亡风险的影响。 结果232例老年AKI患者，其中男性215例，女性17例，平均年龄(86.7±5.3)岁。28d内死亡38例(16.4%)，29d至3个月内死亡19例(9.8%)。感染(43.1%)为AKI最常见病因，其它原因依次为低血容量(19%)、肾毒性药物(16.8%)和心血管事件(15.1%）等。多因素Logistic回归分析显示低体质量指数(BMI）、少尿、机械通气、血清白蛋白(Alb)降低、血清肌酐(Scr)峰值(246.5μmol/L)是影响老年AKI患者28d时预后的因素(均P0.05)；低BMI、Alb降低及血尿素氮(BUN)增高是影响老年AKI患者29d至3个月时预后的因素(均P0.05)。 结论感染、低血容量、肾毒性药物、心血管事件等是诱发老年AKI最常见的原因；低BMI、少尿、机械通气、Alb降低、BUN增高、Scr峰值(246.5μmol/L)是影响老年AKI患者预后的危险因素。 第二部分 高龄患者机械通气后并发急性肾损伤危险因素的分析 目的对行机械通气的老年患者进行随访观察，分析高龄患者机械通气后急性肾损伤(AKI)的发生率、相关病因及危险因素。方法选择2008年1月~2012年12月就诊于解放军总医院老年病房的260例机械通气患者为研究对象，根据机械通气后是否发生AKI分为AKI组和非AKI组进行分析。采用单因素分析初步筛查出影响预后的因素，将有统计学意义的因素为自变量进行Logistic回归分析，判断各因素对AKI的影响。 结果260例机械通气患者，平均年龄(88.9±5)岁；机械通气后共有125例(48.1%)患者发生AKI。机械通气后发生AKI的平均时间(1.6±0.7)天。两组患者相比，年龄、体质量指数(BMI)的差异无统计学意义。患者伴有冠心病、慢性阻塞性肺疾病、高血压比例在AKI组稍高于非AKI组，但差异无统计学意义。伴有慢性肾脏病(CKD)、糖尿病病史者，AKI组明显高于非AKI组(66.4%比51.1%，51.2%比38.5%)，差异具有统计学意义(P=0.012，P=0.040);与非AKI组相比，AKI组PaO2降低(59.7±12.8比63.6±14.1，P=0.021)和氧合指数(PaO2/FiO2)降低者(122.5±42.0比145.7±46.0，P=0.000)明显增多，血红蛋白(105±23比100±17，P=0.046)、血糖水平(10.2±4.1比8.8±3.7，P=0.004)稍有增高，差异具有统计学意义；当呼气末正压（PEEP）设定值≥4cmH2O时，AKI发生率更高(21.6%比10.4%)，，差异具有统计学意义(P=0.013)；多因素Logistic回归分析显示CKD(OR=1.964)、高血糖(OR=1.076)、低PaO2/FiO2(OR=2.142)和高PEEP值(≥4cmH2O, OR=0.990)是影响高龄患者接受机械通气后发生AKI的主要危险因素(均P0.05)。 结论高龄患者机械通气后AKI的发生率为48.1%；CKD、高血糖、低PaO2/FiO2和治疗中使用高PEEP值(≥4cmH2O)是高龄患者接受机械通气后发生AKI的独立危险因素。 第三部分 高龄患者机械通气后短期预后及危险因素的分析 目的对行机械通气的老年患者进行随访观察，分析机械通气的短期预后及危险因素。 方法选择2008年1月~2013年6月就诊于解放军总医院老年病房的270例机械通气患者为研究对象，根据机械通气后至28d时段和29d至3个月时段患者的生存情况，将患者资料分成死亡组和存活组进行分析，采用单因素分析筛查出影响预后的因素，以有统计学意义的因素作为自变量进行多因素Logistic回归分析，判断各因素对死亡风险的影响。 结果270例老年机械通气患者，平均年龄(89.0±4.8)岁。肺部感染(70.7%)是行机械通气最常见病因，其它原因依次为急性左心衰(10.7%)和慢性阻塞性肺疾病急性加重(AECOPD,7.8%)等。28d内死亡86例(31.9%)，29d至3个月内死亡40例(21.7%)。多因素logistic回归分析显示低氧合指数(PaO2/FiO2)、前白蛋白(Pre-Alb)降低、血尿素氮(BUN)增高、血清肌酐(Scr)增高(165.2μmol/L)、使用呼吸末正压(PEEP)是影响老年机械通气患者28d预后的危险因素(均P0.05)；慢性肾脏病(CKD)、C-反应蛋白(CRP)是影响老年机械通气患者29d至3个月时预后的危险因素(均P0.05)。 结论肺部感染、急性左心衰、AECOPD等是高龄患者机械通气最常见的原因；CKD、低PaO2/FiO2、Pre-Alb降低、CRP、BUN增高、Scr增高(165.2μmol/L)及使用PEEP是影响高龄机械通气患者预后的主要危险因素。
文内图片：
图片说明：AKI发生后28d内、29d至3个月内死亡患者死亡原因(例)
[Abstract]:the first part Short-term prognosis and risk factors of acute renal injury in the aged Objective To observe the short-term prognosis and risk of AKI in elderly patients with acute renal injury (AKI). Methods:232 patients with AKI from January 2008 to December 2009 in the old ward of the General Hospital of the PLA were selected as the subjects, and the patient's medical records were divided into the death group and the surviving group according to the survival condition of the patients after the period of AKI to 28d and the period from 29d to 3 months. The group was analyzed, and the factors influencing the prognosis were screened by t-test or Pearson X2 test. The multivariate logistic regression analysis of the independent variables was performed to judge the death of each factor. The impact of the risk was found in 232 elderly patients with AKI, including 215 males,17 females, mean age (86.7% 5.3) years,38 cases (16.4%) in 28 days, and 19 deaths in 29 d to 3 months. (9.8%). The infection (43.1%) was the most common cause of AKI, and the other causes were hypovolemia (19%), nephrotoxicity (16.8%), and cardiovascular events (8%). The multivariate logistic regression analysis showed that the low body mass index (BMI), oliguria, mechanical ventilation, serum albumin (Alb) decreased, and the peak value of serum myoglobin (Scr) (246.5. mu.mol/ L) was the factor that affected the prognosis of the elderly patients with AKI (all P0.05). 5) The decrease of low BMI, Alb and the increase of blood urea nitrogen (BUN) are the factors that affect the prognosis of patients with AKI in the aged from 29d to 3 months. Conclusion Infection, low blood volume, nephrotoxic drugs and cardiovascular events are the most common causes of AKI in the elderly. Low BMI, oliguria, mechanical ventilation, Alb decrease, BUN increase, and Scr peak (246.5. mu.mol/ L) are the most common causes of AKI in the elderly. Patient's prognosis Risk factors. After mechanical ventilation in the second part of the patient The purpose of the analysis of the risk factors of acute renal injury was to follow up the elderly patients with mechanical ventilation and to analyze the acute renal injury (AKI) after mechanical ventilation in the elderly. Methods:260 cases of mechanical ventilation in the old ward of the General Hospital of the PLA from January 2008 to December 2012 were selected as the study subjects, and the AKI score after mechanical ventilation was determined. The analysis of AKI group and non-AKI group was carried out. The factors influencing the prognosis were first screened by single factor analysis, and the statistical significance of the factors was Logistic regression with the independent variables. The effect of each factor on AKI was determined, and the average age of 260 patients with mechanical ventilation was 88.9 (5) years; after mechanical ventilation, a total of 1 25 (48.1%) of the patients had AKI. After mechanical ventilation, A The average time of KI (1.6 to 0.7) days. The age, body mass, The difference of the mass index (BMI) was not statistically significant. The patient was associated with coronary heart disease, chronic obstructive pulmonary disease, and the proportion of hypertension was a little in the AKI group. The difference was statistically significant (P = 0.012, P = 0.040) in the AKI group compared with the non-AKI group (P = 0.012, P = 0.040). .7 (12.8, 63.6, 14.1, P = 0.021) and Oxygenation Index (PaO2/ FiO2) (122.5, 42.0, 145.7, 46.0, P = 0.000), hemoglobin (105,23,100,17, P = 0.046), blood glucose level (10.2, 4.1, 8.8, 3.7, P = 0.0) The incidence of AKI was higher (21.6% vs 10.4%) and the difference was statistically significant (P = 0.013). The multivariate logistic regression analysis showed that CKD (OR = 1.964), hyperglycemia (OR = 1.076), low PaO2/ FiO2 (OR = 2.14) 2) and the high PEEP (1994cmH2O, OR = 0.990) is the occurrence of A in the elderly patients after mechanical ventilation The main risk factors of KI (P0.05). Conclusion The incidence of AKI was 48.1% after mechanical ventilation in the aged patients, and the high PEEP was used in the treatment of CKD, hyperglycemia, low PaO2/ FiO2 and the treatment. receiving machine Independent risk factors for AKI after ventilation. Part 3 The purpose of the analysis of short-term prognosis and risk factors for the elderly patients with mechanical ventilation for elderly patients with mechanical ventilation The short-term prognosis and risk factors of mechanical ventilation were analyzed by follow-up observation, and 270 mechanical ventilation patients from January 2008 to June 2013 in the old ward of the General Hospital of the Liberation Army were selected as the study subjects, and according to the period of 28d after mechanical ventilation and from 29d to 3 months, The survival of the patients was analyzed, the data of the patient was divided into the death group and the survival group, and the factors influencing the prognosis were screened by single factor analysis. Logistic regression analysis to determine the effect of each factor on the risk of death. The average age of 270 elderly patients with mechanical ventilation (89.0-4.8) was the most common cause of mechanical ventilation. The other causes were acute left heart failure (10.7%) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 7.8%). 40 patients (21.7%) died within 29 d to 3 months (31.9%). The multivariate logistic regression analysis showed that the hypoxia-combined index (PaO2/ FiO2), prealbumin (Pre-Alb) decreased, blood urea nitrogen (BUN) increased, serum myoglobin (Scr) increased (165.2. mu.mol/ L), and positive positive pressure (PEEP) was used. The risk factors that affect the prognosis of the patients with mechanical ventilation in the aged (all P0.05), chronic kidney disease (CKD) and C-reactive protein (CRP) are the factors that affect the old age. Lung infection, acute left heart failure, AECOPD, etc. were the most common cause of mechanical ventilation in the elderly, and CKD, low PaO 2/ FiO2, Pre-Alb decreased, CRP, BUN increased, and Scr increased (165.2. mu.mo)
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692
本文编号：2512279
文内图片：
图片说明：AKI发生后28d内、29d至3个月内死亡患者死亡原因(例)
[Abstract]:the first part Short-term prognosis and risk factors of acute renal injury in the aged Objective To observe the short-term prognosis and risk of AKI in elderly patients with acute renal injury (AKI). Methods:232 patients with AKI from January 2008 to December 2009 in the old ward of the General Hospital of the PLA were selected as the subjects, and the patient's medical records were divided into the death group and the surviving group according to the survival condition of the patients after the period of AKI to 28d and the period from 29d to 3 months. The group was analyzed, and the factors influencing the prognosis were screened by t-test or Pearson X2 test. The multivariate logistic regression analysis of the independent variables was performed to judge the death of each factor. The impact of the risk was found in 232 elderly patients with AKI, including 215 males,17 females, mean age (86.7% 5.3) years,38 cases (16.4%) in 28 days, and 19 deaths in 29 d to 3 months. (9.8%). The infection (43.1%) was the most common cause of AKI, and the other causes were hypovolemia (19%), nephrotoxicity (16.8%), and cardiovascular events (8%). The multivariate logistic regression analysis showed that the low body mass index (BMI), oliguria, mechanical ventilation, serum albumin (Alb) decreased, and the peak value of serum myoglobin (Scr) (246.5. mu.mol/ L) was the factor that affected the prognosis of the elderly patients with AKI (all P0.05). 5) The decrease of low BMI, Alb and the increase of blood urea nitrogen (BUN) are the factors that affect the prognosis of patients with AKI in the aged from 29d to 3 months. Conclusion Infection, low blood volume, nephrotoxic drugs and cardiovascular events are the most common causes of AKI in the elderly. Low BMI, oliguria, mechanical ventilation, Alb decrease, BUN increase, and Scr peak (246.5. mu.mol/ L) are the most common causes of AKI in the elderly. Patient's prognosis Risk factors. After mechanical ventilation in the second part of the patient The purpose of the analysis of the risk factors of acute renal injury was to follow up the elderly patients with mechanical ventilation and to analyze the acute renal injury (AKI) after mechanical ventilation in the elderly. Methods:260 cases of mechanical ventilation in the old ward of the General Hospital of the PLA from January 2008 to December 2012 were selected as the study subjects, and the AKI score after mechanical ventilation was determined. The analysis of AKI group and non-AKI group was carried out. The factors influencing the prognosis were first screened by single factor analysis, and the statistical significance of the factors was Logistic regression with the independent variables. The effect of each factor on AKI was determined, and the average age of 260 patients with mechanical ventilation was 88.9 (5) years; after mechanical ventilation, a total of 1 25 (48.1%) of the patients had AKI. After mechanical ventilation, A The average time of KI (1.6 to 0.7) days. The age, body mass, The difference of the mass index (BMI) was not statistically significant. The patient was associated with coronary heart disease, chronic obstructive pulmonary disease, and the proportion of hypertension was a little in the AKI group. The difference was statistically significant (P = 0.012, P = 0.040) in the AKI group compared with the non-AKI group (P = 0.012, P = 0.040). .7 (12.8, 63.6, 14.1, P = 0.021) and Oxygenation Index (PaO2/ FiO2) (122.5, 42.0, 145.7, 46.0, P = 0.000), hemoglobin (105,23,100,17, P = 0.046), blood glucose level (10.2, 4.1, 8.8, 3.7, P = 0.0) The incidence of AKI was higher (21.6% vs 10.4%) and the difference was statistically significant (P = 0.013). The multivariate logistic regression analysis showed that CKD (OR = 1.964), hyperglycemia (OR = 1.076), low PaO2/ FiO2 (OR = 2.14) 2) and the high PEEP (1994cmH2O, OR = 0.990) is the occurrence of A in the elderly patients after mechanical ventilation The main risk factors of KI (P0.05). Conclusion The incidence of AKI was 48.1% after mechanical ventilation in the aged patients, and the high PEEP was used in the treatment of CKD, hyperglycemia, low PaO2/ FiO2 and the treatment. receiving machine Independent risk factors for AKI after ventilation. Part 3 The purpose of the analysis of short-term prognosis and risk factors for the elderly patients with mechanical ventilation for elderly patients with mechanical ventilation The short-term prognosis and risk factors of mechanical ventilation were analyzed by follow-up observation, and 270 mechanical ventilation patients from January 2008 to June 2013 in the old ward of the General Hospital of the Liberation Army were selected as the study subjects, and according to the period of 28d after mechanical ventilation and from 29d to 3 months, The survival of the patients was analyzed, the data of the patient was divided into the death group and the survival group, and the factors influencing the prognosis were screened by single factor analysis. Logistic regression analysis to determine the effect of each factor on the risk of death. The average age of 270 elderly patients with mechanical ventilation (89.0-4.8) was the most common cause of mechanical ventilation. The other causes were acute left heart failure (10.7%) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 7.8%). 40 patients (21.7%) died within 29 d to 3 months (31.9%). The multivariate logistic regression analysis showed that the hypoxia-combined index (PaO2/ FiO2), prealbumin (Pre-Alb) decreased, blood urea nitrogen (BUN) increased, serum myoglobin (Scr) increased (165.2. mu.mol/ L), and positive positive pressure (PEEP) was used. The risk factors that affect the prognosis of the patients with mechanical ventilation in the aged (all P0.05), chronic kidney disease (CKD) and C-reactive protein (CRP) are the factors that affect the old age. Lung infection, acute left heart failure, AECOPD, etc. were the most common cause of mechanical ventilation in the elderly, and CKD, low PaO 2/ FiO2, Pre-Alb decreased, CRP, BUN increased, and Scr increased (165.2. mu.mo)
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692
【参考文献】
相关期刊论文 前2条
1 连晓峰;;中长期机械通气患者死亡危险因素分析[J];临床医学;2013年01期
2 齐玉琴;伏杭江;陈雪松;张兴虎;万文辉;刘玉亭;;高龄患者肺部感染致多器官功能不全综合征的临床分析[J];中华保健医学杂志;2011年03期
本文编号：2512279
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