中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
5期
366-370
,共5页
高建波%张茂%方国英%叶立刚%唐卫东
高建波%張茂%方國英%葉立剛%唐衛東
고건파%장무%방국영%협립강%당위동
造影剂肾病%危重患者%影响因素%预后
造影劑腎病%危重患者%影響因素%預後
조영제신병%위중환자%영향인소%예후
Contrast induced acute kidney injury%Critically ill%Risk factor%Outcome
目的：评价造影剂的使用是否会增加危重患者急性肾损伤（AKI）的发生，并评估危重患者造影剂肾病（CI-AKI）发生的危险因素及其与预后的关系。方法本研究为回顾性观察性研究，选择2011年1月1日至2014年12月31日浙江省富阳市人民医院重症加强治疗病房（ICU）接受过CT检查、且住院时间超过48 h的患者，肾脏替代治疗患者除外。将患者按是否使用造影剂分为两组。AKI的诊断参照急性肾损伤协作网（AKIN）标准，即48 h内血肌酐（SCr）水平较前升高50%或＞26.4μmol/L。通过医院电子信息系统查询患者信息，比较两组患者AKI的发生率；通过多因素logistic回归分析危重患者发生CI-AKI的高危因素，以及CI-AKI与患者预后的关系。结果共纳入危重患者2370例，使用造影剂的474例患者中有70例（14.8%）发生CI-AKI，未使用造影剂的1896例患者中有235例（12.4%）发生AKI；两组AKI发生率比较差异无统计学意义（χ2＝1.905，P＝0.168）。校正混杂因素后，经多因素logistic回归分析显示，造影剂的使用不会明显增加AKI的发生率〔优势比（OR）＝1.66，95%可信区间（95%CI）＝0.72～3.90，P＝0.201〕，而急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分增加（OR＝1.70，95%CI＝1.33～2.40，P＜0.001）、脓毒症（OR＝8.06，95%CI＝3.28～17.80，P＜0.001）、休克（OR＝3.57，95%CI＝1.73～8.01，P＜0.001）、使用肾毒性药物（OR＝1.96，95%CI＝1.25～2.63，P＝0.015）是使用造影剂的危重患者发生CI-AKI的危险因素。70例CI-AKI患者中住院期间死亡10例（14.3%），使用造影剂未发生AKI的404例患者中死亡21例（5.2%）；两组住院病死率比较差异有统计学意义（χ2＝8.060，P＝0.005）。多因素logistic回归分析显示，高龄（OR＝1.30，95%CI＝1.05～1.71， P＝0.027）、男性（OR＝1.13，95%CI＝1.05～1.20，P＝0.039）、 APACHEⅡ评分（OR＝1.07，95%CI＝1.03～1.18， P＜0.001）、脓毒症（OR＝3.29，95%CI＝1.92～6.46，P＜0.001）是使用造影剂的危重患者死亡的高危因素，而CI-AKI的发生并不是影响患者死亡的危险因素（OR＝1.70，95%CI＝0.88～3.56，P＝0.227）。结论造影剂的应用不会明显增加危重患者CI-AKI的发生率；CI-AKI不会明显增加患者住院病死率。
目的：評價造影劑的使用是否會增加危重患者急性腎損傷（AKI）的髮生，併評估危重患者造影劑腎病（CI-AKI）髮生的危險因素及其與預後的關繫。方法本研究為迴顧性觀察性研究，選擇2011年1月1日至2014年12月31日浙江省富暘市人民醫院重癥加彊治療病房（ICU）接受過CT檢查、且住院時間超過48 h的患者，腎髒替代治療患者除外。將患者按是否使用造影劑分為兩組。AKI的診斷參照急性腎損傷協作網（AKIN）標準，即48 h內血肌酐（SCr）水平較前升高50%或＞26.4μmol/L。通過醫院電子信息繫統查詢患者信息，比較兩組患者AKI的髮生率；通過多因素logistic迴歸分析危重患者髮生CI-AKI的高危因素，以及CI-AKI與患者預後的關繫。結果共納入危重患者2370例，使用造影劑的474例患者中有70例（14.8%）髮生CI-AKI，未使用造影劑的1896例患者中有235例（12.4%）髮生AKI；兩組AKI髮生率比較差異無統計學意義（χ2＝1.905，P＝0.168）。校正混雜因素後，經多因素logistic迴歸分析顯示，造影劑的使用不會明顯增加AKI的髮生率〔優勢比（OR）＝1.66，95%可信區間（95%CI）＝0.72～3.90，P＝0.201〕，而急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分增加（OR＝1.70，95%CI＝1.33～2.40，P＜0.001）、膿毒癥（OR＝8.06，95%CI＝3.28～17.80，P＜0.001）、休剋（OR＝3.57，95%CI＝1.73～8.01，P＜0.001）、使用腎毒性藥物（OR＝1.96，95%CI＝1.25～2.63，P＝0.015）是使用造影劑的危重患者髮生CI-AKI的危險因素。70例CI-AKI患者中住院期間死亡10例（14.3%），使用造影劑未髮生AKI的404例患者中死亡21例（5.2%）；兩組住院病死率比較差異有統計學意義（χ2＝8.060，P＝0.005）。多因素logistic迴歸分析顯示，高齡（OR＝1.30，95%CI＝1.05～1.71， P＝0.027）、男性（OR＝1.13，95%CI＝1.05～1.20，P＝0.039）、 APACHEⅡ評分（OR＝1.07，95%CI＝1.03～1.18， P＜0.001）、膿毒癥（OR＝3.29，95%CI＝1.92～6.46，P＜0.001）是使用造影劑的危重患者死亡的高危因素，而CI-AKI的髮生併不是影響患者死亡的危險因素（OR＝1.70，95%CI＝0.88～3.56，P＝0.227）。結論造影劑的應用不會明顯增加危重患者CI-AKI的髮生率；CI-AKI不會明顯增加患者住院病死率。
목적：평개조영제적사용시부회증가위중환자급성신손상（AKI）적발생，병평고위중환자조영제신병（CI-AKI）발생적위험인소급기여예후적관계。방법본연구위회고성관찰성연구，선택2011년1월1일지2014년12월31일절강성부양시인민의원중증가강치료병방（ICU）접수과CT검사、차주원시간초과48 h적환자，신장체대치료환자제외。장환자안시부사용조영제분위량조。AKI적진단삼조급성신손상협작망（AKIN）표준，즉48 h내혈기항（SCr）수평교전승고50%혹＞26.4μmol/L。통과의원전자신식계통사순환자신식，비교량조환자AKI적발생솔；통과다인소logistic회귀분석위중환자발생CI-AKI적고위인소，이급CI-AKI여환자예후적관계。결과공납입위중환자2370례，사용조영제적474례환자중유70례（14.8%）발생CI-AKI，미사용조영제적1896례환자중유235례（12.4%）발생AKI；량조AKI발생솔비교차이무통계학의의（χ2＝1.905，P＝0.168）。교정혼잡인소후，경다인소logistic회귀분석현시，조영제적사용불회명현증가AKI적발생솔〔우세비（OR）＝1.66，95%가신구간（95%CI）＝0.72～3.90，P＝0.201〕，이급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분증가（OR＝1.70，95%CI＝1.33～2.40，P＜0.001）、농독증（OR＝8.06，95%CI＝3.28～17.80，P＜0.001）、휴극（OR＝3.57，95%CI＝1.73～8.01，P＜0.001）、사용신독성약물（OR＝1.96，95%CI＝1.25～2.63，P＝0.015）시사용조영제적위중환자발생CI-AKI적위험인소。70례CI-AKI환자중주원기간사망10례（14.3%），사용조영제미발생AKI적404례환자중사망21례（5.2%）；량조주원병사솔비교차이유통계학의의（χ2＝8.060，P＝0.005）。다인소logistic회귀분석현시，고령（OR＝1.30，95%CI＝1.05～1.71， P＝0.027）、남성（OR＝1.13，95%CI＝1.05～1.20，P＝0.039）、 APACHEⅡ평분（OR＝1.07，95%CI＝1.03～1.18， P＜0.001）、농독증（OR＝3.29，95%CI＝1.92～6.46，P＜0.001）시사용조영제적위중환자사망적고위인소，이CI-AKI적발생병불시영향환자사망적위험인소（OR＝1.70，95%CI＝0.88～3.56，P＝0.227）。결론조영제적응용불회명현증가위중환자CI-AKI적발생솔；CI-AKI불회명현증가환자주원병사솔。
ObjectiveTo assess whether intravenous contrast medium would result in acute kidney injury (AKI), and to determine the risk factors associated with contrast induced AKI (CI-AKI) and its outcome.Methods A retrospective observational study was conducted in intensive care unit (ICU) of Fuyang People's Hospital in Zhejiang Province from January 1st 2011 to December 31st 2014. All enrolled critically ill patients had accepted CT scan, and the hospital length of stay was longer than 48 hours, and the patients who needed renal replacement treatment were excluded. Patients were divided into contrast medium group and control group. AKI was defined according to Acute Kidney Injury Network (AKIN) criteria (serum creatinine content over 26.4μmol/L or 50% increase of it from baseline within 48 hours). The incidence of AKI was compared between the two groups, and risk factors for CI-AKI were determined by multiple logistic regression analysis. The relationship of CI-AKI and outcomes were also analyzed. Results A total of 2 370 critically ill patients were enrolled during the period. 474 (20.0%) of the 2 370 patients received contrast medium, and 70 of them suffered from CI-AKI (14.8%). In 1 896 patients who did not receive contrast medium, 235 of them suffered from AKI (12.4%). There was no significant difference in the incidence of AKI between two groups (χ2= 1.905,P = 0.168). After several confounding factors were adjusted, multiple logistic regression analysis showed that contrast medium was not found to associate with AKI in critically ill patients [odds ratio (OR) = 1.66, 95% confidence interval (95%CI) = 0.72-3.90,P = 0.201], and high acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (OR = 1.70, 95%CI = 1.33-2.40,P< 0.001), sepsis (OR= 8.06, 95%CI =3.28-17.80,P< 0.001), shock (OR= 3.57, 95%CI = 1.73-8.01,P< 0.001) and use of nephrotoxic agent (OR= 1.96, 95%CI = 1.25-2.63,P = 0.015) were risk factors of CI-AKI. Ten of 70 patients with CI-AKI died (14.3%), and 21 out of 404 patients without CI-AKI, died (5.2%). There was no significant difference in the mortality rate (χ2= 8.060, P = 0.005). It was shown by multiple logistic regression analysis that age (OR=1.30, 95%CI = 1.05-1.71,P = 0.027), male sex (OR = 1.13, 95%CI = 1.05-1.20,P = 0.039), APACHEⅡscore (OR = 1.07, 95%CI = 1.03-1.18,P< 0.001), and sepsis (OR = 3.29, 95%CI = 1.92-6.46,P< 0.001) were highly associated with mortality of critically ill patients in whom contrast medium was used. However, the occurrence of CI-AKI showed no influence on the mortality rate (OR = 1.70, 95%CI = 0.88-3.56,P = 0.227).Conclusions The use of contrast medium is not a risk factor of CI-AKI in critically ill patients. CI-AKI will not raise mortality rate in ICU patients.
