中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
4期
409-412
,共4页
重症医学科%急性肾损伤%血清胱抑素C%急性生理功能和慢性健康状况评分系统Ⅱ%少尿%预后%回顾性分析
重癥醫學科%急性腎損傷%血清胱抑素C%急性生理功能和慢性健康狀況評分繫統Ⅱ%少尿%預後%迴顧性分析
중증의학과%급성신손상%혈청광억소C%급성생리공능화만성건강상황평분계통Ⅱ%소뇨%예후%회고성분석
Intensive Care Unit%Acute kidney injury%Serum Cystatin C%APACHE II%01iguria%Prognosis%Retrospective studies
目的 通过分析重症医学科(intensive care uint,ICU)内急性肾损伤(acute kidney injury,AKI)患者高病死率的影响因素.筛选与其相关的临床预后指标.方法 回顾性分析2008年3月至2009年8月在西安交通大学第二附属医院和中南大学湘雅医院ICU内收治的符合急性肾损伤诊断标准患者的临床资料,排除ICU未满24 h死亡患者、既往慢性肾脏病史及资料不完整的患者,按60 d生存状态将患者分为存活组和病死组,统计其性别,年龄、慢性疾病史、24 h内相关临床化验指标(血常规、血气分析、肝肾功能、血清胱抑素C浓度,血电解质等)的最差值,并对其进行急性病理生理学和慢性健康评价(APACHE)Ⅱ评分及确诊后60 d病死率.采用t检验、χ~2检验行两组问变量的差异比较,再应用单因素Logistic回归分析,计算比值比(OR)和95%可信区间(CI),并对筛选出的危险凶素进行多因素Logistic 回归分析各种因素与病死率之间的关系.结果 纳入病例98例,男60例,女38例,年龄19～89岁,(52.4 ±16.1)岁;到确诊后60 d为止,死亡34例,死亡率34.7%.病死组患者A-PACHEU评分(17.4±4.3)分高于存活组(14.2±4.8)分,P＜0.05.血清胱抑素(Cystatin C)＞1.3 ms/L的AKI患者死亡率为50%(24/48),高于血清Cystatin C＜1.3 mg/L的患者(20%,10/50;P＜0.05).单因素分析显示,器官衰竭数目t≥2个,少尿,APACHEⅡ＞15分,Cystatin C＞1.3 mg/L、Cystatin C＞1.3mg/L+APACHEⅡ＞15分与AKI患者死亡率相关,Logistic多因素[口j归分析显示:器官衰竭数目≥2个、少尿、Cystatin C＞1.3 ms/L结合APACHEⅡ＞15分是急性肾损伤患者的独立死亡危险因素.结论 Cystatin C＞1.3 mg/L结合APACHEⅡ＞15分可以作为评价AKI患者预后的指标.
目的 通過分析重癥醫學科(intensive care uint,ICU)內急性腎損傷(acute kidney injury,AKI)患者高病死率的影響因素.篩選與其相關的臨床預後指標.方法 迴顧性分析2008年3月至2009年8月在西安交通大學第二附屬醫院和中南大學湘雅醫院ICU內收治的符閤急性腎損傷診斷標準患者的臨床資料,排除ICU未滿24 h死亡患者、既往慢性腎髒病史及資料不完整的患者,按60 d生存狀態將患者分為存活組和病死組,統計其性彆,年齡、慢性疾病史、24 h內相關臨床化驗指標(血常規、血氣分析、肝腎功能、血清胱抑素C濃度,血電解質等)的最差值,併對其進行急性病理生理學和慢性健康評價(APACHE)Ⅱ評分及確診後60 d病死率.採用t檢驗、χ~2檢驗行兩組問變量的差異比較,再應用單因素Logistic迴歸分析,計算比值比(OR)和95%可信區間(CI),併對篩選齣的危險兇素進行多因素Logistic 迴歸分析各種因素與病死率之間的關繫.結果 納入病例98例,男60例,女38例,年齡19～89歲,(52.4 ±16.1)歲;到確診後60 d為止,死亡34例,死亡率34.7%.病死組患者A-PACHEU評分(17.4±4.3)分高于存活組(14.2±4.8)分,P＜0.05.血清胱抑素(Cystatin C)＞1.3 ms/L的AKI患者死亡率為50%(24/48),高于血清Cystatin C＜1.3 mg/L的患者(20%,10/50;P＜0.05).單因素分析顯示,器官衰竭數目t≥2箇,少尿,APACHEⅡ＞15分,Cystatin C＞1.3 mg/L、Cystatin C＞1.3mg/L+APACHEⅡ＞15分與AKI患者死亡率相關,Logistic多因素[口j歸分析顯示:器官衰竭數目≥2箇、少尿、Cystatin C＞1.3 ms/L結閤APACHEⅡ＞15分是急性腎損傷患者的獨立死亡危險因素.結論 Cystatin C＞1.3 mg/L結閤APACHEⅡ＞15分可以作為評價AKI患者預後的指標.
목적 통과분석중증의학과(intensive care uint,ICU)내급성신손상(acute kidney injury,AKI)환자고병사솔적영향인소.사선여기상관적림상예후지표.방법 회고성분석2008년3월지2009년8월재서안교통대학제이부속의원화중남대학상아의원ICU내수치적부합급성신손상진단표준환자적림상자료,배제ICU미만24 h사망환자、기왕만성신장병사급자료불완정적환자,안60 d생존상태장환자분위존활조화병사조,통계기성별,년령、만성질병사、24 h내상관림상화험지표(혈상규、혈기분석、간신공능、혈청광억소C농도,혈전해질등)적최차치,병대기진행급성병리생이학화만성건강평개(APACHE)Ⅱ평분급학진후60 d병사솔.채용t검험、χ~2검험행량조문변량적차이비교,재응용단인소Logistic회귀분석,계산비치비(OR)화95%가신구간(CI),병대사선출적위험흉소진행다인소Logistic 회귀분석각충인소여병사솔지간적관계.결과 납입병례98례,남60례,녀38례,년령19～89세,(52.4 ±16.1)세;도학진후60 d위지,사망34례,사망솔34.7%.병사조환자A-PACHEU평분(17.4±4.3)분고우존활조(14.2±4.8)분,P＜0.05.혈청광억소(Cystatin C)＞1.3 ms/L적AKI환자사망솔위50%(24/48),고우혈청Cystatin C＜1.3 mg/L적환자(20%,10/50;P＜0.05).단인소분석현시,기관쇠갈수목t≥2개,소뇨,APACHEⅡ＞15분,Cystatin C＞1.3 mg/L、Cystatin C＞1.3mg/L+APACHEⅡ＞15분여AKI환자사망솔상관,Logistic다인소[구j귀분석현시:기관쇠갈수목≥2개、소뇨、Cystatin C＞1.3 ms/L결합APACHEⅡ＞15분시급성신손상환자적독립사망위험인소.결론 Cystatin C＞1.3 mg/L결합APACHEⅡ＞15분가이작위평개AKI환자예후적지표.
Objective To determine the prognostic indicators of acute kidney injury by comprehensive anal-ysis of the mortality risk factors for AKI. Method It' s a retrospective study. The clinical date form March 2008 to August 2009 were collected and analyzed, including gender, age,case history of chronic diseases, the worst values of laboratory examinations within 24 hours of diagnosis (including routine blood tests, blood gas analysis, liver andrenal function, the levels of serum CystatinC , blood electrolytes). According to the 60-day survival of the state will be divided into the survival group and dead groups, Calculation acute physiology and Chronic health evaluation (A-PACHE) Ⅱ scores and mortality.First,univariate analysis was used to screen the variables that related to Prognosis,Calculate odds ratios (OR) and 95% confidence interval (CI) .then Proceeded multiple-factor analysis with Logis-tic regression among to Perform the variables. Results Of the 98 acute kidney injury cases analyzed, 60 cases were males and 38 females, age ranged form 19 to 89 years (mean age 52.4± 16.1 years) .The overall mortality was 34.7%(34/98) within 60d of final diagnosis.The APACHE Ⅱ scores of the non-survivors (17.4 ± 4.3) were higher than that of the survivors(14.2±4.8, P ＜ 0.05). The mortality of the patients with high Cystatin C(＞ 1.3mg/L) was 50% (24/48), which was higher than that of the patients with low Cystatin C (＜ 1.3 mg/L)(20%,10/50; P ＜0.05).Tne results of the univariate analysis indicated that Organ failure≥ 2, Oliguria、 A-PACHEI1 ＞ 15 scores,Cys C ＞ 1.3 mg/L Cys C ＞ 1.3 mg/L Combined APACHEⅡ＞ 15 scores,were the risk factors of AKI. However the logistic reggression suggessted that Organ failure≥2, Oliguria, Cys C ＞ 1.3 mg/L Combined APACHEⅡ＞ 15 scores are the independent risk factors of AKI. Conclusions Cys C ＞ 1.3 mg/L Combined APACHE Ⅱ＞ 15 scores may be used for the prognosis the patients AKI.
