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目的探讨ICU中脑部疾病治疗过程中发生急性肾损伤(AKI)时影响分期的危险因素和影响其预后的因素。方法收集2011年6月—2015年7月ICU住院患者病历资料,筛选出所有脑部疾病发生AKI的患者,共59例。收集符合条件的脑部疾病发生AKI患者的一般资料[包括年龄、性别、格拉斯哥昏迷评分(GCS评分)、有无慢性疾病]和各种指标(包括肾功能指标、有无休克、是否手术、是否使用肾毒性药物、甘露醇总量,以及预后、住ICU天数和住院费用)。通过急性肾损伤网络(AKIN)诊断标准进行分级,观察患者住院28 d时和出院时的肾脏预后与患者的预后关系,通过单因素方差分析了解AKI与患者预后的关系,并且通过Logistic回归分析研究出影响疾病分期和预后的危险因素。结果统计分析得出AKIⅠ、Ⅱ、Ⅲ级分别占39.0%、30.5%和30.5%,其治愈或好转患者比例占45.8%,而未愈合患者比例占54.2%,所有患者的GCS评分5(4,7)分,甘露醇使用总量1 000(400,1 440)g,使用肾毒性药物的患者22例,所有患者住ICU 14(13,23)d,总花费5.7(4.5,8.6)万元。影响AKI分期的危险因素为:GCS评分、肾毒性药物是否使用和有无合并慢性疾病,影响其转归的因素为:年龄、GCS评分、是否使用肾毒性药物、性别和AKI分级,并且AKI分期越高,住院时间和花费越高。结论脑部疾病并发急性肾损伤的病死率较高,高度重视其各种危险因素,要求临床医师对脑部疾病导致的AKI进行早期预防和早期诊断,能够改善其预后,减轻患者经济负担等。
Objective To investigate the risk factors and prognostic factors of acute kidney injury (AKI) in ICU during the treatment of brain diseases. Methods The data of ICU inpatients from June 2011 to July 2015 were collected and 59 patients with AKI in all brain diseases were screened out. Collecting general information on eligible AKI patients with brain disease [including age, gender, Glasgow coma score (GCS score), presence or absence of chronic diseases] and various indicators (including renal function indicators, whether there is shock, whether surgery, whether Use of nephrotoxic drugs, total mannitol, and prognosis, ICU days and hospitalization costs). The AKIN diagnostic criteria were used to classify the patients. The relationship between AKI and prognosis was observed at 28 days after hospitalization and at the time of discharge, and the relationship between AKI and prognosis was analyzed by one-way ANOVA. Logistic regression analysis Risk factors that affect disease stage and prognosis. Results The statistical analysis showed that the patients with AKI Ⅰ, Ⅱ and Ⅲ accounted for 39.0%, 30.5% and 30.5% respectively, and the cure or improvement rate was 45.8%, while the non-union patients accounted for 54.2% and GCS scores 5 (4, 7), mannitol used in a total of 1 000 (400,1 440) g, the use of nephrotoxic drugs in 22 patients, all patients living ICU 14 (13,23) d, the total cost of 5.7 (4.5,8.6) million . The risk factors affecting the staging of AKI were: GCS score, whether or not nephrotoxic drugs were used and the presence or absence of chronic diseases, and the factors influencing their outcome were age, GCS score, nephrotoxicity, gender and AKI grade, and AKI stage The higher the hospital stay and the higher the cost. Conclusions The morbidity of brain injury complicated by acute renal injury is high, and its risk factors are highly valued. Clinicians are required to make early prevention and early diagnosis of AKI caused by brain diseases, to improve their prognosis and to reduce their financial burden.