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
338-342
,共5页
汪正光%张牧城%汪健蕾%方向群%郑绍鹏%张曲矗
汪正光%張牧城%汪健蕾%方嚮群%鄭紹鵬%張麯矗
왕정광%장목성%왕건뢰%방향군%정소붕%장곡촉
羟乙基淀粉%急性肾损伤%序贯器官衰竭评分%血糖%高血压%休克%危险因素
羥乙基澱粉%急性腎損傷%序貫器官衰竭評分%血糖%高血壓%休剋%危險因素
간을기정분%급성신손상%서관기관쇠갈평분%혈당%고혈압%휴극%위험인소
Hydroxyethyl starch%Acute kidney injury%Sequential organ failure assessment%Blood glucose%Hypertension%Shock%Risk factor
目的：探讨重症患者发生急性肾损伤（AKI）的危险因素，并评价羟乙基淀粉（HES）对重症患者AKI发生的影响。方法采用前瞻性观察性研究方法，选择2012年3月至2013年10月入住皖南医学院附属黄山市人民医院重症医学科的重症患者。记录患者的人口学资料、既往史、入院后情况、病情严重程度、输血及用药情况。根据急性肾损伤协作网（AKIN）标准将入选患者分为AKI组和非AKI组，采用单因素和多因素logistic回归分析重症患者发生AKI的危险因素，并评价HES 130/0.4在其中的作用。结果研究期间医院共收治1152例患者，有314例被纳入本研究，其中89例出现AKI。按AKIN分期标准，1期59例，2期19例，3期11例。单因素分析结果显示：年龄、合并高血压、合并糖尿病、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA）、 SOFA凝血评分、 SOFA神经评分、 SOFA心血管评分、入重症加强治疗病房（ICU）时pH值、入ICU时血糖水平、 HES总剂量和出现休克是重症患者发生AKI的危险因素（P＜0.05或P＜0.01）；而使用HES和HES每日最大剂量不是重症患者发生AKI的危险因素（均P＞0.05）。多因素logistic回归分析显示：SOFA总分〔优势比（OR）＝1.20，95%可信区间（95%CI）＝1.09～1.32，P＜0.001〕、合并高血压（OR＝2.44，95%CI＝1.22～4.89，P＝0.012）、入ICU时血糖水平（OR＝1.85，95%CI＝1.32～2.59，P＜0.001）、出现休克（OR＝3.81，95%CI＝1.93～7.53，P＜0.001）是重症患者发生AKI的独立危险因素，而HES总剂量不是重症患者发生AKI的独立危险因素（OR＝0.77，95%CI为0.68～0.87，P＜0.001）。结论 SOFA总分、合并高血压、入ICU时血糖水平、出现休克是重症患者发生AKI的独立危险因素，而HES可能不是重症患者发生AKI的独立危险因素。
目的：探討重癥患者髮生急性腎損傷（AKI）的危險因素，併評價羥乙基澱粉（HES）對重癥患者AKI髮生的影響。方法採用前瞻性觀察性研究方法，選擇2012年3月至2013年10月入住皖南醫學院附屬黃山市人民醫院重癥醫學科的重癥患者。記錄患者的人口學資料、既往史、入院後情況、病情嚴重程度、輸血及用藥情況。根據急性腎損傷協作網（AKIN）標準將入選患者分為AKI組和非AKI組，採用單因素和多因素logistic迴歸分析重癥患者髮生AKI的危險因素，併評價HES 130/0.4在其中的作用。結果研究期間醫院共收治1152例患者，有314例被納入本研究，其中89例齣現AKI。按AKIN分期標準，1期59例，2期19例，3期11例。單因素分析結果顯示：年齡、閤併高血壓、閤併糖尿病、急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分、序貫器官衰竭評分（SOFA）、 SOFA凝血評分、 SOFA神經評分、 SOFA心血管評分、入重癥加彊治療病房（ICU）時pH值、入ICU時血糖水平、 HES總劑量和齣現休剋是重癥患者髮生AKI的危險因素（P＜0.05或P＜0.01）；而使用HES和HES每日最大劑量不是重癥患者髮生AKI的危險因素（均P＞0.05）。多因素logistic迴歸分析顯示：SOFA總分〔優勢比（OR）＝1.20，95%可信區間（95%CI）＝1.09～1.32，P＜0.001〕、閤併高血壓（OR＝2.44，95%CI＝1.22～4.89，P＝0.012）、入ICU時血糖水平（OR＝1.85，95%CI＝1.32～2.59，P＜0.001）、齣現休剋（OR＝3.81，95%CI＝1.93～7.53，P＜0.001）是重癥患者髮生AKI的獨立危險因素，而HES總劑量不是重癥患者髮生AKI的獨立危險因素（OR＝0.77，95%CI為0.68～0.87，P＜0.001）。結論 SOFA總分、閤併高血壓、入ICU時血糖水平、齣現休剋是重癥患者髮生AKI的獨立危險因素，而HES可能不是重癥患者髮生AKI的獨立危險因素。
목적：탐토중증환자발생급성신손상（AKI）적위험인소，병평개간을기정분（HES）대중증환자AKI발생적영향。방법채용전첨성관찰성연구방법，선택2012년3월지2013년10월입주환남의학원부속황산시인민의원중증의학과적중증환자。기록환자적인구학자료、기왕사、입원후정황、병정엄중정도、수혈급용약정황。근거급성신손상협작망（AKIN）표준장입선환자분위AKI조화비AKI조，채용단인소화다인소logistic회귀분석중증환자발생AKI적위험인소，병평개HES 130/0.4재기중적작용。결과연구기간의원공수치1152례환자，유314례피납입본연구，기중89례출현AKI。안AKIN분기표준，1기59례，2기19례，3기11례。단인소분석결과현시：년령、합병고혈압、합병당뇨병、급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분、서관기관쇠갈평분（SOFA）、 SOFA응혈평분、 SOFA신경평분、 SOFA심혈관평분、입중증가강치료병방（ICU）시pH치、입ICU시혈당수평、 HES총제량화출현휴극시중증환자발생AKI적위험인소（P＜0.05혹P＜0.01）；이사용HES화HES매일최대제량불시중증환자발생AKI적위험인소（균P＞0.05）。다인소logistic회귀분석현시：SOFA총분〔우세비（OR）＝1.20，95%가신구간（95%CI）＝1.09～1.32，P＜0.001〕、합병고혈압（OR＝2.44，95%CI＝1.22～4.89，P＝0.012）、입ICU시혈당수평（OR＝1.85，95%CI＝1.32～2.59，P＜0.001）、출현휴극（OR＝3.81，95%CI＝1.93～7.53，P＜0.001）시중증환자발생AKI적독립위험인소，이HES총제량불시중증환자발생AKI적독립위험인소（OR＝0.77，95%CI위0.68～0.87，P＜0.001）。결론 SOFA총분、합병고혈압、입ICU시혈당수평、출현휴극시중증환자발생AKI적독립위험인소，이HES가능불시중증환자발생AKI적독립위험인소。
ObjectiveTo explore the risk factors of the occurrence of acute kidney injury (AKI) in critically ill patients, and to investigate the effect of hydroxyethyl starch (HES) on renal function in these patients.Methods A prospective investigation was conducted. Critically ill patients admitted to Department of Critical Care Medicine of People's Hospital of Huangshan, Wannan Medical College from March 2012 to October 2013 were enrolled. For all the patients under observation, the following data were collected: demography, comorbidities, clinical presentation, severity of illness, and the use of blood product and drugs. All patients were divided into AKI group and non-AKI group by means of Acute Kidney Injury Network (AKIN) criteria, then the risk factors of AKI were investigated by means of univariate and multivariate logistic regression analysis. The effect of HES 130/0.4 administration on renal function in critically ill patients was evaluated.Results 314 patients were enrolled for study out of 1 152 patients admitted. Among these patients enrolled, 89 of them were found to suffer from AKI. AKI was classified as stage 1 in 59 patients, stage 2 in 19 patients, and stage 3 in 11 patients. It was shown by the univariate analysis that 12 variables were the risk factors of AKI, including age, hypertension, diabetes mellitus, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, coagulation SOFA score, neurological SOFA score, cardiovascular SOFA score, blood pH on intensive care unit (ICU) admission, blood glucose on ICU admission, accumulating dose of HES, and presence of shock (P< 0.05 orP< 0.01). However, HES administration and daily maximum dose of HES were not the risk factors of AKI in critically ill patients (bothP> 0.05). Using the multivariate logistic regression analysis, it was shown that total SOFA score [odds ratio (OR) = 1.20, 95% confidence interval (95%CI) = 1.09-1.32,P< 0.001], hypertension (OR = 2.44, 95%CI = 1.22-4.89,P= 0.012), blood glucose level on ICU admission (OR= 1.85, 95%CI = 1.32-2.59,P< 0.001), and presence of shock (OR = 3.81, 95%CI = 1.93-7.53,P< 0.001) were independent predictors of AKI in critically ill patients, however, the cumulative dose of HES was not independent risk factor for AKI (OR = 0.77, 95%CI = 0.68-0.87,P< 0.001).Conclusions Total SOFA score, hypertension, blood glucose level on ICU admission, and presence of shock were independent risk factors for AKI in critically ill patients. HES administration may not be a causative factor of an increased risk of AKI in the ICU.
