危重新生儿急性肾损伤的高危因素分析
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摘要
目的:探讨危重新生儿急性肾损伤(acute kidney injury,AKI)死亡的高危因素。方法:将新生儿重症监护室(NICU)收治的78例AKI新生儿纳入本研究,收集整理其临床资料,对AKI的病因及影响AKI预后的因素进行回顾性分析。结果:78例AKI患者中,早产儿占55.13%;死亡44例,存活34例,死亡率为56.41%。引起AKI的原发病中最常见的是重症感染。多因素Logistic回归分析显示,低Apgar评分、低前白蛋白、血钾异常是危重新生儿AKI死亡的高危因素。结论:重症感染是NICU中新生儿AKI发生的主要原因。低Apgar评分、低前白蛋白、血钾异常是AKI死亡的高危因素,须引起临床医师的警惕。
Objective:To investigate the death risk factors of acute kidney injury(AKI) in serious neonates.Methods:Seventy-eight neonates with AKI hospitalized in the neonatal intensive care unit(NICU) were recruited to this retrospective study.The clinical data and laboratory test results were collected and the etiology of AKI and factors of effecting prognosis were analyzed.Results:Among the 78 patients,premature accounted for 55.13%;44 patients were died and 34 patients were surviving.The mortality was 56.41%.The common disease causing AKI was serious infection.Multifactorial Logistic regression model suggested that low level of Apgar score,low level of prealbumin,potassium anomaly were high risk factors of death in patients with AKI.Conclusion:In NICU,serious infection is the most common diseases resulted in AKI.Low level of Apgar score,low level of prealbumin,potassium anomaly are the high risk factors of death for neonates with AKI.Clinical doctors should pay much attention on it.
Objective:To investigate the death risk factors of acute kidney injury(AKI) in serious neonates.Methods:Seventy-eight neonates with AKI hospitalized in the neonatal intensive care unit(NICU) were recruited to this retrospective study.The clinical data and laboratory test results were collected and the etiology of AKI and factors of effecting prognosis were analyzed.Results:Among the 78 patients,premature accounted for 55.13%;44 patients were died and 34 patients were surviving.The mortality was 56.41%.The common disease causing AKI was serious infection.Multifactorial Logistic regression model suggested that low level of Apgar score,low level of prealbumin,potassium anomaly were high risk factors of death in patients with AKI.Conclusion:In NICU,serious infection is the most common diseases resulted in AKI.Low level of Apgar score,low level of prealbumin,potassium anomaly are the high risk factors of death for neonates with AKI.Clinical doctors should pay much attention on it.
引文
[1]HOLMES J,ROBERTS G,MAY K,et al.The incidence of pediatric acute kidney injury is increased when identified by a change in a creatinine-based electronic alert[J].Kidney Int,2017,92(2):432-439.
[2]LEE C C,CHAN O W,LAI M Y,et al.Incidence and outcomes of acute kidney injury in extremely-low-birth-weight infants[J].PLo S One,2017,12(11):.e0187764.
[3]AI MALLA M,VARGHESE N V,ALABDULLATIF M,et al.Prevalence and outcome of acute kidney injury,as defined by the new Kidney Disease Improving Global Outcomes Guideline,in very low birth weight infants[J].World J Nephrol,2017,6(5):229-235.
[4]CARMODY J B,SWANSON J R,RHONE E T,et al.Recognition and reporting of AKI in very low birth weight infants[J].Clin J Am Soc Nephrol,2014,9(12):2036-2043.
[5]易着文,刘琳.急性肾损伤的定义、诊断及治疗[J].临床儿科杂志,2009,27:301-306.
[6]SELEWSKI D T,CHARLTON J R,JETTON J G,et al.Neonatal acute kidney injury[J].Pediatrics,2015,136(2):e463-473.
[7]SARAN R,ROBINSON B,ABBOTT K C,et al.US renal data system 2016 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2017,69(3S1):A7-A8.
[8]KHWAJA A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.
[9]LEE S T,CHO H.Fluid overload and outcomes in neonates receiving continuous renal replacement therapy[J].Pediatr Nephrol,2016,31(11):2145-2152.
[10]MAQSOOD S,FUNG N,CHOWDHARY V,et al.Outcome of extremely low birth weight infants with a history of neonatal acute kidney injury[J].Pediatr Nephrol,2017,32(6):1035-1043.
[11]NAGARAJ N,BERWAL P K,SRINIVAS A,et al.A study of acute kidney injury in hospitalized preterm neonates in NICU[J].J Neonatal Perinatal Med,2016,9(4):417-421.
[12]MOMTAZ H E,SABZEHEI M K,RASULI B,et al.The main etiology of acute kidney injury in the newborns hospitalized in the neonatal in intensive care unit[J].J Clin Neonatol,2014,3(2):99-102.
[13]TIMOVSKA S N,CEKOVSKA S,TOSHESKA-TRAJKOVSKAK.Acute kidney injury in newborns[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2015,36(3):83-89.
[2]LEE C C,CHAN O W,LAI M Y,et al.Incidence and outcomes of acute kidney injury in extremely-low-birth-weight infants[J].PLo S One,2017,12(11):.e0187764.
[3]AI MALLA M,VARGHESE N V,ALABDULLATIF M,et al.Prevalence and outcome of acute kidney injury,as defined by the new Kidney Disease Improving Global Outcomes Guideline,in very low birth weight infants[J].World J Nephrol,2017,6(5):229-235.
[4]CARMODY J B,SWANSON J R,RHONE E T,et al.Recognition and reporting of AKI in very low birth weight infants[J].Clin J Am Soc Nephrol,2014,9(12):2036-2043.
[5]易着文,刘琳.急性肾损伤的定义、诊断及治疗[J].临床儿科杂志,2009,27:301-306.
[6]SELEWSKI D T,CHARLTON J R,JETTON J G,et al.Neonatal acute kidney injury[J].Pediatrics,2015,136(2):e463-473.
[7]SARAN R,ROBINSON B,ABBOTT K C,et al.US renal data system 2016 annual data report:epidemiology of kidney disease in the United States[J].Am J Kidney Dis,2017,69(3S1):A7-A8.
[8]KHWAJA A.KDIGO clinical practice guidelines for acute kidney injury[J].Nephron Clin Pract,2012,120(4):c179-c184.
[9]LEE S T,CHO H.Fluid overload and outcomes in neonates receiving continuous renal replacement therapy[J].Pediatr Nephrol,2016,31(11):2145-2152.
[10]MAQSOOD S,FUNG N,CHOWDHARY V,et al.Outcome of extremely low birth weight infants with a history of neonatal acute kidney injury[J].Pediatr Nephrol,2017,32(6):1035-1043.
[11]NAGARAJ N,BERWAL P K,SRINIVAS A,et al.A study of acute kidney injury in hospitalized preterm neonates in NICU[J].J Neonatal Perinatal Med,2016,9(4):417-421.
[12]MOMTAZ H E,SABZEHEI M K,RASULI B,et al.The main etiology of acute kidney injury in the newborns hospitalized in the neonatal in intensive care unit[J].J Clin Neonatol,2014,3(2):99-102.
[13]TIMOVSKA S N,CEKOVSKA S,TOSHESKA-TRAJKOVSKAK.Acute kidney injury in newborns[J].Pril(Makedon Akad Nauk Umet Odd Med Nauki),2015,36(3):83-89.