论文部分内容阅读
目的分析老年重症肺炎患者并发急性肾损伤(acate kidney injury,AKI)的发病情况及危险因素。方法收集海军总医院呼吸重症监护病房2013年7月1日至2015年2月28日住院的老年重症肺炎患者资料,以改善全球肾脏病预后组织(KDIGO)推荐的AKI定义筛选出AKI患者,比较AKI患者、非AKI患者的临床资料及其预后,采用logistic回归分析AKI的危险因素。结果入选的138例重症肺炎患者中87例(63%)发生AKI,其中AKI 1期41例(29.7%),AKI 2期23例(16.7%),AKI 3期23例(16.7%)。AKI组的住院期间死亡率明显较非AKI组高(P<0.001),AKI的分级越高,死亡的风险增加(P<0.001)。两组住院时间差异无统计学意义(P=0.40)。多因素二分类logistic回归分析显示,慢性肾脏疾病史[相对比值比(OR)=65.759,95%可信区间(CI):6.555~659.661,P<0.001]、机械通气史(OR=6.165,95%CI:2.137~17.788,P=0.001)、APACHE-II评分(OR=1.192,95%CI:1.070~1.329,P=0.001)、肾外器官衰竭数(OR=2.918,95%CI:1.261~6.751,P=0.012)是AKI发生的独立危险因素。结论老年重症肺炎住院期间发生AKI的风险高,肾损伤程度重,预后差。慢性肾脏疾病史、机械通气史、APACHEⅡ评分、肾外器官衰竭数目是罹患AKI的独立危险因素。
Objective To analyze the incidence and risk factors of acute kidney injury (AKI) in elderly patients with severe pneumonia. Methods The data of patients with severe pneumonia admitted to the Respiratory Care Unit of the Navy General Hospital between July 1, 2013 and February 28, 2015 were collected to improve the AKI definition recommended by the Global Kidney Disease Outcomes Organization (KDIGO). AKI patients were screened and compared AKI patients, non-AKI patients with clinical data and prognosis, the use of logistic regression analysis of AKI risk factors. Results Of 138 patients with severe pneumonia, 87 (63%) had AKI. Among them, 41 (29.7%) were AKI1, 23 (16.7%) were AKI2 and 23 (16.7%) were AKI3. Mortality during hospitalization was significantly higher in the AKI group than in the non-AKI group (P <0.001). The higher the AKI grade, the greater the risk of death (P <0.001). There was no significant difference in hospitalization time between the two groups (P = 0.40). Multivariate logistic regression analysis showed that the incidence of chronic kidney disease (OR = 65.759, 95% CI: 6.555-659.661, P <0.001), history of mechanical ventilation (OR = 6.165, 95 (OR = 2.918, 95% CI: 1.261 ~ 0.797, P = 0.001), APACHE-II score (OR = 1.192, 95% CI: 1.070-1.329, 6.751, P = 0.012) is an independent risk factor for AKI. Conclusion The risk of AKI during hospitalization for severe pneumonia in elderly patients is high, and the severity of renal injury is severe with poor prognosis. The history of chronic kidney disease, history of mechanical ventilation, APACHE II score and number of extra-renal organ failure are independent risk factors for AKI.