极低出生体质量儿急性肾损伤的危险因素及结局分析

摘要

目的 探讨极低出生体质量(VLBW)儿发生急性肾损伤(AKI)的危险因素.方法 回顾分析2012年1月至2016年12月收治的出生日龄≤3天的VLBW新生儿的临床资料.根据KDIGO改良的新生儿AKI标准,比较其中发生AKI(AKI组)与未发生AKI(NAKI组)新生儿的差异,并分析发生AKI的危险因素及AKI婴儿死亡的危险因素.结果 313例VLBW新生儿中126例发生AKI,发生率为40.3％.与NAKI组相比,AKI组的胎龄、出生体质量、5分钟Apgar评分、危重评分、平均动脉压更低,母亲年龄更大,发生胎膜早破更多,合并呼吸衰竭等发生率更高,入院时白细胞计数、降钙素原值更大,白蛋白、血钠更低,出生时有创机械通气更多,机械通气时间更长,病死率更高,差异均有统计学意义(P<0.05).多因素logistic回归分析发现,胎龄小、呼吸衰竭、出生时有创机械通气为VLBW新生儿发生AKI的独立危险因素;入院时酸中毒程度越重、伴随肺出血是AKI患儿死亡的独立危险因素.结论 胎龄小、呼吸衰竭、出生时有创机械通气会显著增加VLBW新生儿发生AKI的风险,代谢性酸中毒程度重、伴随肺出血会显著增加AKI患儿的死亡风险.%Objective To explore the risk factors of acute kidney injury (AKI) in very low birth weight (VLBW) infants. Method The clinical data of 313 VLBW newborns aged under 3 days from January 2012 to December 2016 were retrospectively analyzed. According to the improved KDIGO standard of neonatal AKI, the difference between AKI (group AKI) and non AKI (group NAKI) newborns was compared, and the risk factors of AKI and mortality of AKI infants were analyzed. Results In the 313 VLBW infants, 126 had AKI and the incidence rate was 40.3％. There were 53 cases at stage 1 (42.1％), 43 cases at stage 2 (34.1％), and 30 cases at stage 3 (23.8％). Compared with NAKI group, patients in AKI group were lower in gestational age, birth weight, 5-minute Apgar score, critical score and mean arterial pressure. Furthermore, AKI group was higher in mother's age, incidence of premature rupture of membranes and respiratory failure. Also, white blood cells number and procalcitonin level were higher; albumin and sodium levels were lower; more cases had invasive mechanical ventilation after birth; time of mechanical ventilation was longer; mortality were higher in AKI group. There were statistically differences (P<0.05). Multivariate logistic regression analysis showed that gestational age, respiratory failure and invasive mechanical ventilation at birth were independent risk factors for AKI in VLBW infants. More severe acidosis and associated pulmonary hemorrhage at admission were the independent risk factors for the death caused by AKI in children. Conclusions Short gestational age, respiratory failure, and invasive mechanical ventilation at birth significantly increased the risk of AKI in VLBW infants. The more severe metabolic acidosis and pulmonary hemorrhage increased the risk of death in AKI children .