蜂蜇伤后急性肾损伤的临床特征及其危险因素分析

摘要

Objective:To identify the clinical features and risk factors of patients with acute kidney injury ( AKI) following bee stings in Sichuan. Methods:We retrospectively analyzed the clinical material of 385 patients with bee stings who admitted to the emer-gency department of 9 hospitals in Sichuan during January 1,2010 and December 31,2011,and evaluated the risk factors of bee stings related AKI with Logistic Regression Analysis,the influence of AKI on death with Fisher exact probability method. Results:The morbid-ity of AKI in these bee stings patients was 10. 1%. The mortality of AKI patients was significantly higher than that of non AKI group. Compared with the non AKI group,patients in the AKI group were older,had higher proportion with history of cardiovascular disease or bee stings injury history,higher proportion of multiple stings and allergic reactions,longer sting to treatment time,and higher mean arte-rial pressure at admission (P<0. 05). Logistic regression analysis showed that multiple stings,previous history of bee stings,longer sting to treatment time,higher mean arterial pressure and bee stings anaphylaxis were the independent risk factors of AKI occurred in patients with bee stings (P<0. 05). Conclusion:Multiple stings,previous history of bee stings,longer sting to treatment time,higher mean arterial pressure and bee stings anaphylaxis were the independent risk factors of AKI occurred in patients with bee stings.%目的：：分析蜂蜇伤后急性肾损伤( acute kidney injury,AKI)的临床特征、危险因素及其对预后的影响。方法：回顾性分析四川省不同地区9家医院急诊科就诊的蜂蜇伤病例,采集患者一般信息、就诊时病情及就诊后接受治疗的情况,并随访患者预后情况。采用非条件Logistic逐步回归法分析蜂蜇伤后AKI发生危险因素；Fisher确切概率法分析发生AKI对患者死亡风险的影响。结果：(1)本组蜂蜇伤患者AKI发生率为10.1%,AKI组患者的病死率显著高于非AKI组；(2)与非AKI组相比,AKI组患者的年龄较大,既往有心血管疾病病史和蜂蜇伤史,此次为多处蜇伤和蜇伤后发生过敏反应的比率更高,蜇伤到就诊时间更长,就诊时平均动脉压(MAP)更高(P<0.05)；(3)多因素分析显示多处蜇伤、既往有蜂蜇伤史、蜇伤到就诊时间长、就诊时MAP高以及出现过敏反应为患者蜂蜇伤后发生AKI的独立危险因素(P<0.05)。结论：多处蜇伤、既往有蜂蜇伤史、蜇伤到就诊时间长、就诊时MAP高以及出现过敏反应均为患者蜂蜇伤后发生AKI的独立危险因素。