中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2012年
10期
765-768
,共4页
段磊%曾嵘%孔玉科%王俭勤%杨晓燕%杨克虎%李幼平
段磊%曾嶸%孔玉科%王儉勤%楊曉燕%楊剋虎%李幼平
단뢰%증영%공옥과%왕검근%양효연%양극호%리유평
颅脑损伤%肾功能不全,急性%格拉斯哥昏迷评分
顱腦損傷%腎功能不全,急性%格拉斯哥昏迷評分
로뇌손상%신공능불전,급성%격랍사가혼미평분
Craniocerebral trauma%Renal insufficiency,acute%Glasgow coma scale score
目的 研究颅脑损伤后急性肾损伤(AKI)的发病情况及其危险因素.方法 采用前瞻性队列研究,收集我院2008年1月1日至2010年1月1日收治的颅脑损伤患者的临床资料.颅脑损伤诊断:明确的脑外伤病史,头颅CT证实,格拉斯哥昏迷(GCS)评分.AKI诊断标准:48 h内Scr上升≥26.4 μmol/L或较基础值增加≥50％ ;和(或)尿量＜0.5 ml·kg-1·h-1达6h.应用多因素回归方法筛选颅脑损伤患者发生AKI的危险因素.结果 791例患者颅脑损伤后AKI的发病率为39.4％,发生AK1的颅脑损伤患者住院病死率为27.9％,其死亡风险较非AKI患者增加5.065倍(P＜0.01).GCS评分≤8分(重型)者AKI的发病率为69.7％,显著高于中型和轻型两组(P＜0.01).多因素非条件Logistic回归分析显示,GCS评分低(≤8分)、低血压(收缩压＜90 mm Hg)、年龄(每增加10岁)、男性是颅脑损伤患者发生AKI的独立危险因素,OR值分别为2.932、2.176、1.789、1.544.结论 AKI是颅脑损伤患者常见的并发症.GCS评分低、低血压、高龄、男性是颅脑损伤患者发生AKI的独立危险因素.
目的 研究顱腦損傷後急性腎損傷(AKI)的髮病情況及其危險因素.方法 採用前瞻性隊列研究,收集我院2008年1月1日至2010年1月1日收治的顱腦損傷患者的臨床資料.顱腦損傷診斷:明確的腦外傷病史,頭顱CT證實,格拉斯哥昏迷(GCS)評分.AKI診斷標準:48 h內Scr上升≥26.4 μmol/L或較基礎值增加≥50％ ;和(或)尿量＜0.5 ml·kg-1·h-1達6h.應用多因素迴歸方法篩選顱腦損傷患者髮生AKI的危險因素.結果 791例患者顱腦損傷後AKI的髮病率為39.4％,髮生AK1的顱腦損傷患者住院病死率為27.9％,其死亡風險較非AKI患者增加5.065倍(P＜0.01).GCS評分≤8分(重型)者AKI的髮病率為69.7％,顯著高于中型和輕型兩組(P＜0.01).多因素非條件Logistic迴歸分析顯示,GCS評分低(≤8分)、低血壓(收縮壓＜90 mm Hg)、年齡(每增加10歲)、男性是顱腦損傷患者髮生AKI的獨立危險因素,OR值分彆為2.932、2.176、1.789、1.544.結論 AKI是顱腦損傷患者常見的併髮癥.GCS評分低、低血壓、高齡、男性是顱腦損傷患者髮生AKI的獨立危險因素.
목적 연구로뇌손상후급성신손상(AKI)적발병정황급기위험인소.방법 채용전첨성대렬연구,수집아원2008년1월1일지2010년1월1일수치적로뇌손상환자적림상자료.로뇌손상진단:명학적뇌외상병사,두로CT증실,격랍사가혼미(GCS)평분.AKI진단표준:48 h내Scr상승≥26.4 μmol/L혹교기출치증가≥50％ ;화(혹)뇨량＜0.5 ml·kg-1·h-1체6h.응용다인소회귀방법사선로뇌손상환자발생AKI적위험인소.결과 791례환자로뇌손상후AKI적발병솔위39.4％,발생AK1적로뇌손상환자주원병사솔위27.9％,기사망풍험교비AKI환자증가5.065배(P＜0.01).GCS평분≤8분(중형)자AKI적발병솔위69.7％,현저고우중형화경형량조(P＜0.01).다인소비조건Logistic회귀분석현시,GCS평분저(≤8분)、저혈압(수축압＜90 mm Hg)、년령(매증가10세)、남성시로뇌손상환자발생AKI적독립위험인소,OR치분별위2.932、2.176、1.789、1.544.결론 AKI시로뇌손상환자상견적병발증.GCS평분저、저혈압、고령、남성시로뇌손상환자발생AKI적독립위험인소.
Objective To investigate the incidence and risk factors of acute kidney injury (AKI) after craniocerebral injury.Methods A single cohort of 791 patients who suffered from craniocerebral injury from January 2008 to January 2010 in the Second Hospital of Lanzhou University were prospectively analyzed.Craniocerebral injury was defined according to definite medical history of craniocerebral injury,the verification of CT and Glasgow coma scale (GCS) score.AKI was defined as a relative 50％ increase or an absolute increment of 26.4 μmol/L in Scr within 48 hours and/or urine volume ＜0.5 ml·kg-1·h-1 up to 6 h.Multivariate Logistic regression analysis was used to evaluate possible risk factors associated with post-craniocerebral injury AKI.Results Of the 791 patients,the incidence of AKI was 39.4％.In hospital mortality of AKI patients was 27.9％,which was 5.065 times of non-AKI patients (P＜0.01).The incidence of AKI in patients with lower GCS score (≤8 score,heavy group)was 69.7％,which was significantly higher as compared to moderate and mild groups (P＜0.01).Unconditional multivariate Logistic regression analysis revealed that lower GCS score (≤ 8 score),hypotension (systolic pressure＜90 mm Hg),elderly and male were the independent predictors of AKI episodes,the corresponding OR values were 2.932,2.176,1.789,1.544 respectively.Conclusions AKI is a common complication after craniocerebral injury.Lower GCS score,hypotension,elderly and male are the independent risk factors of AKI in patients after craniocerebral injury.
