高血压脑出血术后发生急性肾衰竭的危险因素分析

发布时间：2018-06-01 16:55

本文选题：脑出血 + 急性肾衰竭　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：急性肾衰竭（Acute renal failure ARF）是高血压脑出血术后常见的并发症之一，越来越受到临床医师的重视，也给神经外科术后常用药像甘露醇、抗生素的应用带来限制，严重影响患者的预后，加重了患者住院时间及经济负担。因此，积极探索脑出血术后ARF的危险因素，为寻找有效的预防及治疗措施提供依据。方法：收集我院神经外科高血压脑出血术后患者230例，对其危险因素进行分析，选用Excel软件建立数据库，使用SAS.8.02统计分析软件进行变量的赋值及统计分析。单因素分析时计量资料以均数±标准差(x±S)表示，计数资料采用X2检验，多因素分析采用Logistics回归分析，P＜0.05为差异有统计学意义。结果: 按照ARF的诊断标准，回顾性分析了230例病例，术后发生了ARF75例。单因素分析：发生ARF组患者的平均年龄（57.75+10.26）高于未发生ARF组（45.63+11.59）；发生ARF组的平均ICU住院天数（7.43±4.65）明显高于未发生ARF组（3.11±4.12）；手术时间越长，，术后ARF发生率越高，手术时间＜2h，术后ARF发生率16.67%，手术时间2h～4h，术后ARF发生率22.92%，手术时间4h～6h，术后ARF发生率36.08%，手术时间＞6h，术后ARF发生率64.00%；术后GCS评分3~8分、9~12分、13~15分患者的术后ARF发生率分别为48.52%、31.68%、16.39%；术后发生ARF的患者平均甘露醇总剂量（5280.42g）高于未发生ARF患者的甘露醇总剂量（3523.76g）；术后抗生素应用时间越长，术后ARF发生率越高；术后输血的患者ARF发生率（43.69%）高于未输血的患者（23.62%）。多因素非条件的logistic回归分析结果显示甘露醇总剂量、抗生素应用时间、术后GCS评分是高血压脑出血术后发生ARF的独立危险因素。结论：患者年龄、手术时间、ICU住院时间、术后体温、术后输血是高血压脑出血术后发生ARF的危险因素；术后应用甘露醇总剂量，术后GCS评分，术后应用抗生素时间是高血压脑出血术后发生ARF的独立危险因素；参考既往报告其他疾病术后与ARF关系，说明脑出血是特殊疾病，治疗期间需要有特殊的治疗方式。脑出血后合并ARF不是孤立于脑出血的泌尿系统疾病，ARF是脑出血疾病的一个表现层面。
[Abstract]:Objective: Acute renal failure ARF) is one of the common complications after hypertensive intracerebral hemorrhage, which is paid more and more attention by clinicians. It also restricts the use of common drugs such as mannitol and antibiotics after neurosurgery, and seriously affects the prognosis of patients. Increased patient hospitalization time and economic burden. Therefore, we should explore the risk factors of ARF after intracerebral hemorrhage and provide evidence for effective prevention and treatment. Methods: A total of 230 patients with hypertensive intracerebral hemorrhage after neurosurgery in our hospital were collected and their risk factors were analyzed. Excel software was used to establish the database and SAS.8.02 statistical analysis software was used to assign and analyze the variables. In univariate analysis, the measurement data were expressed as mean 卤standard deviation (x 卤S), the count data were measured by X2 test, and the multivariate analysis was performed by Logistics regression analysis (P < 0. 05). Results: According to the diagnostic criteria of ARF, 230 cases of ARF75 were analyzed retrospectively. Univariate analysis showed that the average age of ARF group was 57.75 10.26) higher than that of ARF group (45.63 11.59), the average ICU hospitalization time of ARF group was 7.43 卤4.65) and the average ICU hospitalization time of ARF group was 3.11 卤4.120.The longer the operation time, the higher the incidence of postoperative ARF. The operative time was less than 2 hours, the postoperative ARF rate was 16.67 hours, the operative time was 2 hours and 4 hours, the postoperative ARF rate was 22.922 hours, the operative time was 4 hours and 6 hours, the postoperative ARF rate was 36.08 hours, the operative time was more than 6 hours, the postoperative ARF incidence rate was 64.00; the postoperative GCS score was 3 ~ 8 points, 9 ~ 12 minutes and 13 ~ 15 minutes, respectively. The average total dose of mannitol in patients with ARF after operation was 5280.42g), which was higher than that in patients without ARF (3523.76g). The higher the incidence of postoperative ARF, the higher the incidence of ARF in the patients with postoperative blood transfusion (43.69%) than in the patients without blood transfusion (23.62%). The results of multivariate non-conditional logistic regression analysis showed that the total dose of mannitol, the time of antibiotic use and the postoperative GCS score were independent risk factors for ARF after hypertensive intracerebral hemorrhage. Conclusion: Age, operation time, postoperative body temperature, postoperative blood transfusion were the risk factors of ARF after hypertensive intracerebral hemorrhage, total dose of mannitol, postoperative GCS score, total dose of mannitol after operation, The time of application of antibiotics was an independent risk factor for ARF after hypertensive intracerebral hemorrhage, and the relationship between ARF and other diseases was reported in the past, which indicated that ICH was a special disease and special treatment was needed during the period of treatment. ARF after intracerebral hemorrhage is not a urological disease isolated from intracerebral hemorrhage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34;R692.5

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