摘要
目的分析住院超高龄患者急性肾损伤(AKI)发病后死亡相关因素。方法回顾性分析2016年1月-2018年1月三亚市人民医院收治的住院超高龄患者513例。其中200例患者住院期间发生AKI,出院12个月内死亡67例(死亡组),存活133例(存活组)。分析患者死亡原因,单因素和Logistic多因素分析住院超高龄患者AKI发病后死亡的相关因素。结果脓毒症、休克、心功能不全、肾毒性药物为患者死亡的主要原因。经单因素分析,死亡组和存活组患者的年龄、体重指数(BMI)、基础疾病、AKI病因、肾小球滤过率(GFR)、平均动脉压、机械通气、尿量<0.05 ml/(kg·h)、AKI发生时各指标、AKI类型和AKI分期的差异有统计学意义(P<0.05)。死亡组患者较存活组年龄高、BMI低、高血压发生率低、低血压和高尿酸血症发生率高,感染所致AKI发生率高,肾毒性药物所致AKI发生率低,GFR水平高,AKI发生时平均动脉压低,机械通气和尿量<0.05 ml/(kg·h)发生率高,尿酸、Scr峰值、Scr、尿素氮、血钙、血磷水平较高,血清前白蛋白、血红蛋白、血镁水平较低,AKI多为持续型,多为Ⅲ期患者,住院时间较长。Logistic多因素分析结果显示,高龄、低血压、伴发感染、平均动脉压降低、尿量<0.05 ml/(kg·h)、尿素氮升高、血清前白蛋白降低、高AKI分期、住院时间长为住院超高龄患者AKI发病后死亡的危险因素(P<0.05)。结论高龄、低血压、伴发感染、平均动脉压降低、尿量<0.05 ml/(kg·h)、尿素氮升高、血清前白蛋白降低、高AKI分期、住院时间长为住院超高龄患者AKI发病后死亡的危险因素,临床中应加强对此类患者的监控,以提高患者生存率。
Objective To analyze the related factors of death after acute kidney injury(AKI) in hospitalized elderly patients. Methods The clinical data of 513 inpatients with super-aged patients admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed. Among them, 200 patients developed acute kidney injury during hospitalization. Within 12 months after discharge, 67 patients died and 133 patients survived. Death causes of the patient were analyzed, and the single factor and Logistic multivariate analysis were used to analyze the factors associated with death after AKI in hospitalized patients. Results Sepsis, shock, cardiac insufficiency and nephrotoxic drugs were the main causes of death. Univariate analysis showed age, body mass index(BMI), underlying disease, AKI etiology, glomerular filtration rate(eGFR), creatinine(Scr), mean arterial pressure, mechanical ventilation, urine volume < 0.05 ml/(kg·h), differences of AKI, AKI type and AKI stage were statistically significant(P<0.05). Patients in the death group had higher age, lower BMI, higher incidence of hypertension, hypotension and hyperuricemia than the surviving group, high incidence of AKI due to infection, low incidence of AKI due to nephrotoxic drugs, high eGFR levels. When AKI occurs, mean arterial pressure was low;mechanical ventilation and urine volume < 0.05 ml/(kg·h) had high incidence;and uric acid, Scr peak, Scr, urea nitrogen, blood calcium and phosphorus levels were high;the level of serum prealbumin, hemoglobin, blood magnesium was low;the most incidence of AKI was continuous, mostly in stage III patients;and the hospital stay was long. Logistic multivariate analysis showed that advanced age, hypotension, infection, low mean arterial pressure, urine output < 0.05 ml/(kg·h), elevated urea nitrogen, decreased serum prealbumin, high AKI stage, and long hospital stay were risk factors of death after AKI in elderly hospitalized patients(P<0.05). Conclusions Advanced age, hypotension, infection, mean arterial pressure reduction, urine output <0.05 ml/(kg·h), elevated urea nitrogen, serum prealbumin reduction, high AKI staging, long hospital stay are risk factors of death for elderly hospitalized patients with AKI, and such patients should be monitored in the clinic to improve patient survival.
作者
林丽娟
陈兴强
陈洁
Li-juan Lin;Xing-qiang Chen;Jie Chen(Department of Nephrology,Sanya People's Hospital,Sanya,Hainan 572000)
出处
《中国现代医学杂志》
CAS
2020年第1期115-119,共5页
China Journal of Modern Medicine
