重组人促红素对预防急腹症患者急性肾损伤的作用研究.docVIP

重组人促红素对预防急腹症患者急性肾损伤的作用研究 目的：探讨使用重组人促红素（CHO细胞）进行预防性治疗是否对急腹症患者发生急性肾损伤（AKI）具有保护作用。 方法 ：选取2012.9-2013.2天津市人民医院普外科以急腹症收入院患者，其中住院时间超过72小时、病史资料完整的患者137人，同时根据AKI发生的独立危险因素包括年龄≥65岁、慢性肾脏病、血容量不足、慢性心力衰竭等选择高危患者37人进行随机分组，对照组19人给予常规治疗，实验组18人在常规治疗基础上增加预防性使用CHO治疗，比较两组患者AKI的发生率。 结果：37例存在发生AKI高危因素的急腹症患者中，共发生AKI 25人，AKI发生率为 67.6%，AKI相关危险因素包括慢性肾脏病、血容量不足、低白蛋白血症、慢性心力衰竭。 对照组19人中发生AKI 15人，AKI发生率为78.9%；实验组18人中AKI发生10人， AKI发生率为55.6%，两组比较AKI的发生率差异有统计学意义（P＜0.05）。 结论： 预防性使用CHO治疗可以降低急腹症患者AKI的发生率。 关键词：急性肾损伤 急腹症 重组人红细胞生成素 危险因素 预防治疗 Abstract Objective : To investigate the incidence , common causes and prognosis of acute kidney injury (AKI) in surgical abdomen patients, analyse the risk factors for AKI； Methods: This retrospective cohort study was carried out in the emergency surgery department of Tianjin Peoples Hospital between September 2011 and August 2012, the study population consisted of 287 surgical abdomen patients who were hospitalized more than 72 hours, and were recorded medical data adequately. Than the 287 patients were assigned into AKI group and non-AKI group, compared the clinical data between the two groups, analyzed the clinical characteristics and the etiology, distribution characteristics and prognosis of AKI, and the multivariate analysis(Logistic regression) were used to identify the risk factors of AKI in acute abdomen patients . Results: 83 cases complicated with AKI in 287 patients, the overall incidence of AKI was 28.92%, the male to female ratio of patients with AKI was 1.9:1, the interquartile range of age was 54.5-75 years old, and the median age was 62 years old. The main cause of AKI was prerenal (37cases). According to KDIGO criteria , 56 cases(67.47%)were at AKIⅠphase, 17 cases(20.48% )were at AKIⅡ phase, 10 cases(12.05%)were at AKI Ⅲ phrase .Till leaving hospital, 58 cases (69.88%) recovered renal function fully , 18 cases (21. 69%) patients got partial recovery, and 7 patients were not recovered (8.43%), 6 cases died (7.23%). 8 (9.64%) patients received hemodi