急性肾损伤合并消化道出血危险因素剖析.docVIP

急性肾损伤合并消化道出血危险因素剖析 　　【摘要】目的 观察急性肾损伤合并急性消化道出血患者临床特征、发病情况、病因、疾病危险因素及预后。方法 回顾性总结分析了山西省人民医院近5年确诊急性肾损伤512例患者，对其消化道出血的临床危险因素、住院病死率及相关独立预测因子进行研究。结果 急性肾损伤合并消化道出血53例，上消化道出血45例，临床严重出血 15例，消化道出血独立危险因素是心功能衰竭、机械通气、血小板减少、慢性肝病、肝硬化及急性肾损伤3期的患者。伴有消化道出血住院病死率 52.8%，不伴有消化道出血患者病死率22.2%。伴有消化道出血病死率明显高于其他患者。结论 消化道出血是急性肾损伤常见合并症。而且以上消化道出血更常见。消化道出血与急性肾损伤病死率增加密切相关。肾脏以及肾脏以外其他危险因素与消化道出血发生有关。 　　【关键词】急性肾损伤；消化道出血；危险因素 　　Analysis on risk factors acute kidney injury complicated by acute gastrointestinal hemorrhage WEN Tao， LUO Yan-kun， LIU Gao-hong， ZHANG Cai-xiang， YAN Cheng-yen. Nephrology Department， Shanxi Province People Hospial， Tai Yuan 030012， China 　　Corresponding auhor： WEN Tao， Email： wentao580116@ 　　【Abstract】Objective Few prospective data are currently available on acute gastrointestinal hemorrhage （AGIH） as a complication in acute kidney injury （AKI）. The aim of the present study was to find out clinical characteristics， incidence， etiology，risk factors，and outcomeof AGIH in patients withAKI.Methods We performed a prospective study on an inceptione cohprt of 512 patients admitted for AKI in our hospital. Data on clinical risk factors for bleeding， frequency of occurrence of AGIH， in-hospital mortalitywere collected， and independent predictors of AGIH were identified. Results A total of 53patients had AGIH as a complication of AKI， and 45 were upper AGIH. Fifteen patients had clinically severe bleeding. Independent baseline predictors of AGIH were severity of illness， cardiac failure， mechanical ventilation，low platelet count， chronic hepatic disease， liever cirrhosis， severe AKI. In-hospital mortality was 52.8% in patients with AGIH， and 22.2% in the otherpatients. AGIH was significantly associated with an increase in hospital mortality.Conclusions AGIH are frequent complications of AKI. In this clinical condition， AGIH is more often due to upper gastrointestinal bleeding and is associated with a significantly increased risk of death. Both renal and extrarenal risk factors are rela