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外科术后急性肾损伤发生的危险因素及中医证候要素分析
姚志,孙鲁英,史月欣,李希尧,包乌基斯古冷
0
北京中医药大学东直门医院北京 100700;北京中医药大学北京 100105
摘要:
目的:分析外科术后发生急性肾损伤的危险因素及中医证候要素分布特征,为早期预防和治疗提供依据。方法:回顾性分析2016年1月—2021年1月北京中医药大学东直门医院周围血管科、骨科和普外科住院行手术治疗的416例患者,将患者分为外科术后急性肾损伤组131例,外科术后非急性肾损伤组285例。收集并分析两组患者的一般基本资料、手术相关资料和中医证候分布资料。对外科术后发生急性肾损伤的危险因素进行多因素Logistic回归分析,并探讨外科术后发生急性肾损伤的中医证候要素分布特征。结果:131例外科术后发生急性肾损伤的患者主要集中分布在周围血管科(76.3%),其分期主要以1期为主(84%),病因分布主要是肾性因素(53%)。中医病性以虚实夹杂证多见,虚证类的证候要素以气虚、血虚为主;实证类证候要素中以血瘀、热毒、湿热为主。两组患者在年龄、体质量指数、平均住院日、高血压病史、糖尿病病史、吸烟史、高脂血症、基础肾功能不全、使用抗生素、使用造影剂、术前血肌酐值、术前血尿酸值、术前血红蛋白值、手术时长、术中出血量和手术分级比较差异有统计学意义(P<0.05)。将上述两组间差异有统计学意义的危险因素进行Logistic回归分析,结果显示年龄、高血压、糖尿病、吸烟史、术前血尿酸、基础肾功能不全、抗生素、造影剂、体质量指数、手术时长和术中出血量是外科术后发生急性肾损伤的独立危险因素。结论:年龄、高血压、糖尿病、吸烟史、术前血尿酸、基础肾功能不全、抗生素、造影剂、体质量指数、手术时长和术中出血量是外科术后发生急性肾损伤的独立危险因素。外科术后急性肾损伤患者中医证候要素主要是血瘀、热毒、湿热、气虚、血虚。
关键词:  外科手术  急性肾损伤  危险因素  中医证候要素
DOI:10.3969/j.issn.1007-6948.2022.03.004
投稿时间:2021-09-04
基金项目:国家科技支撑计划(2011BAI10B10);国家科学与技术部重点研发计划资助项目子课题(2018YFC1704304)
Analysis of Risk Factors and TCM Syndrome Elements of Acute Renal Injury after Surgery
YAO Zhi,SUN Lu-ying,SHI Yue-xin
Abstract:
Objective To analyze the risk factors of patients with acute renal injury after surgery and the distribution characteristics of TCM syndrome elements, so as to provide basis for early prevention and treatment. Methods The 416 patients hospitalized in the department of peripheral vascular, orthopedics and general surgery of Dongzhimen hospital of Beijing university traditional Chinese medicine from January 2016 to January 2021 were analyzed retrospectively. The patients were divided into 131 cases of postoperative acute renal injury group and 285 cases of postoperative non acute renal injury group. The general basic situation, operation related data and TCM syndrome distribution data of the two groups were collected and analyzed. The risk factors of acute renal injury after surgery were analyzed by multivariate logistic regression, and the distribution characteristics of TCM syndrome elements of acute renal injury after surgery were discussed. Results 131 patients with postoperative acute renal injury were mainly distributed in the peripheral vascular department of our hospital (76.3%), which the stage was mainly stage 1 (84%), and the etiology was mainly renal factors (53%). The disease nature of traditional Chinese medicine is mostly mixed with deficiency and excess syndrome, and the syndrome elements of deficiency syndrome are mainly Qi deficiency and blood deficiency. Blood stasis, heattoxin and damp heat are the main syndrome elements of empirical syndrome. There were signi.cant differences between the two groups in age, BMI, average length of stay, history of hypertension, history of diabetes, smoking history, hyperlipidemia, basic renal insuf.ciency, antibiotics, contrast media, preoperative creatinine, preoperative blood uric acid value, preoperative hemoglobin value, duration of operation, intraoperative blood loss and surgical classi.cation (P<0.05). Logistic regression analysis was carried out on the risk factors with signi.cant difference between the two groups. The results showed that age, hypertension, diabetes, smoking history, preoperative uric acid, basic renal insuf.ciency, antibiotics, contrast media, BMI, operative duration and intraoperative blood loss were independent risk factors for acute kidney injury after surgery. Conclusion Age, hypertension, diabetes mellitus, smoking history, preoperative serum uric acid, basic renal insuf.ciency, antibiotics, contrast media, body mass index, duration of operation and intraoperative blood loss were independent risk factors for acute kidney injury after surgery. The TCM syndrome elements of patients with acute renal injury after surgery are mainly blood stasis, heat toxin, damp heat, Qi de.ciency and blood de.ciency.
Key words:  Surgery  acute renal injury  risk factors  TCM syndrome elements

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