呼吸衰竭患者中急性肾损伤的发生情况及危险因素分析

目的 了解呼吸衰竭患者中急性肾损伤(AKI)的发生情况,筛选与AKI发生相关的临床危险因素.方法 选择2006年1月至2008年12月于上海交通大学医学院附属仁济医院呼吸科与内科重症监护室住院的235例诊断为呼吸衰竭且资料完整的患者.回顾性收集患者的人口统计学资料、呼吸衰竭前后的临床资料和实验室检查结果.分析患者呼吸衰竭后AKI的发生情况、临床危险因素及住院病死率,并以多因素Logistic回归方程分析与呼吸衰竭后AKI发生相关的独立危险因素.结果 总共235例患者入送,平均年龄(70.05±12.85)岁,男女比例1.90∶1.77例发生AKI,发生率为32.8％.伴有高血压或慢性肾脏病患者AKI的发生率显著增高(44.4％比26.6％;66.7％比31.3％,均P＜ 0.01).机械通气患者AKI的发生率显著高于非机械通气的患者(44.8％比13.3％,P＜0.01).与非AKI患者比较,AKI患者的多脏器功能衰竭比例(33.8％比5.7％,P＜0.01)、呼吸机脱机失败比例(69.2％比32.5％,P＜0.01)、病死率(51.9％比13.3％,P＜0.01)均显著升高.多因素Logistic回归分析显示,患者年龄(OR=1.668)、血红蛋白(OR =0.980)、基础血肌酐(OR=1.071)和机械通气(OR =3.222)是呼吸衰竭患者发生AKi的独立危险因素.结论 呼吸衰竭患者中AKI的发病率和病死率均高.年龄、基础肾功能、贫血和机械通气是呼吸衰竭患者发生AKI的独立危险因素.

Analysis of the incidence and risk factors of acute kidney injury in respiratory failure patients

Objective To determine the incidence and risk factors of acute kidney injury(AKI) in respiratory failure patients. Method Clinical data of 235 patients diagnosed as respiratory failure admitted in respiratory division and internal medicine intensive care unit in Renji Hospital from January 2006 to December 2008 were analyzed retrospectively. Patients' demographics, clinical data and laboratory examinations before and after respiratory failure were collected. The incidence, clinical risk factors and hospital mortality of AKI in the respiratory failure patients were analyzed. Multivariate Logistic regression analysis was used to investigate the independent risk factors of AKI in these patients. Results Of the total 235 patients, the average age was (70.05±12.85) years old, the ratio of male to female was 1.90∶1. Seventy-seven patients developed AKI and the incidence was 32.8%. The incidence of AKI in those with hypertension (44.4% vs 26.6%, P<0.01) or chronic kidney disease(66.7% vs 31.3%, P<0.01) was significantly higher. The incidence of AKI in patients with mechanical ventilation was much higher than those without mechanical ventilation（44.8% vs 13.3%, P<0.01). The incidence of multi-organ system failure (33.8% vs 5.7%, P<0.01), the failure of weaning from mechanical ventilation(69.2% vs 32.5%，P<0.01) and the mortality (51.9% vs 13.3%, P<0.01) in AKI patients were higher than those without AKI. Multivariate Logistic regression analysis showed that age (OR=1.668), anemia (OR=0.980), baseline serum creatinine (OR=1.071) and mechanical ventilation (OR=3.222) were independent risk factors of AKI. Conclusions Incidence and mortality of AKI are quite high in respiratory failure patients. Age, baseline serum creatinine, anemia and mechanical ventilation are independent risk factors of AKI.