多发伤后急性肾损伤的危险因素分析及其对预后的影响

目的探讨多发伤患者并发急性肾损伤(AKI)的危险因素及其预后情况。方法回顾性分析2013年3月~2014年12月收治的352例多发伤患者的临床资料,其中男性234例,女性118例;平均(35.45±8.65)岁。总结急性肾功能衰竭的发生率及其危险因素,如性别、高血压、使用甘露醇、手术史、年龄、损伤程度、糖尿病、大量输量、失血性休克,进一步探讨对患者预后的影响。结果 56例(56/352,15.91%)多发伤患者出现AKI,其中男性40例,女性16例;平均年龄(42.21±11.89)岁。并发和未并发AKI的多发伤患者1个月和1年内死亡率均显著升高(32.14%vs.11.74%,44.64%vs.21.48%)。Logistic回归分析提示年龄(OR 1.209,95%CI 1.102~2.980)、糖尿病(OR 5.899,95%CI 2.578~9.328)、严重损伤(OR 3.056,95%CI 1.786~6.435)、失血性休克(OR 1.690,95%CI 1.279~4.865)与AKI密切相关。随访1年,非死亡患者无发展至终末期肾脏病。结论 AKI是多发伤患者常见的并发症,导致死亡率增加,应引起临床医生的足够重视;年龄、糖尿病、严重损伤、失血性休克是多发伤患者并发急性肾损伤的危险因素。

Analysis on the risk factors and outcome of acute kidney injury secondary to multiple injuries

Objective To explore the risk factors and outcomes of patients with acute kidney injury ( AKI) after multiple injuries.Methods The clinical data of included patients,who were treated for multiple injuries in our hospital from Mar.2013 to Dec.2014,were summarized.Then a retrospective analysis was made to explore inci-dence and risk factors of AKI including gender,hypertension,use of mannitol,expirence of surgeries,age,injury se-verity,diabetes,massive blood transfusion and hemorrhagic shock.And their influences on the outcomes were inves-tigated.Results Totally 56 cases (56/352,15.91%) with multiple injuries developed to AKI,of whom 40 were males and 16 were femalesmean age (42.21 ±11.89) years].In comparison to patients without AKI,those with AKI had significantly higher mortality rates witin 1 month or 1 year after injury,respectively (32.14%vs.11.74%, 44.64%vs.21.48%).Logistic regression analysis showed that age(OR 1.209,95%CI 1.102-2.980),diabetes(OR 5.899,95%CI 2.578~9.328),serious injury(OR 3.056,95%CI 1.786-6.435),and hemorrhagic shock(OR 1.690, 95%CI 1.279-4.865) were closely related to AKI.However,no patients with AKI developed to end-stage renal dis-ease during 1-year follow-up.Conclusion AKI is a common complication in patients with multiple injuries,and in-creases mortality.Age,diabetes,serious injury,and hemorrhagic shock are risk factors for AKI.