儿童患者静脉滴注莲必治注射液致急性肾损伤的危险因素分析

目的:探讨儿童患者使用莲必治注射液致急性肾损伤(AKI)的危险因素,为临床用药提供数据。方法:采用回顾性研究方法,收集2016年1月至2018年3月我院使用莲必治注射液的1876例儿童患者的病历资料,根据AKI诊断标准分为AKI组85例和非AKI组1791例,比较两组患儿的一般情况、原患疾病、合并用药、莲必治注射液用药情况等多种因素,分析发生AKI的危险因素。结果:我院使用莲必治注射液的患儿AKI发生率为4.53%(85/1876)。单因素方差分析显示,两组患儿在年龄、入住ICU比例、血清肌酐水平、内生肌酐清除率、合并用药(氨基糖苷类、阿昔洛韦、利巴韦林、血管升压药、安痛定)、日给药剂量和输液浓度方面比较差异有统计学意义(P均<0.05)。进一步Logistic回归分析显示,高输液浓度、高日给药剂量、低内生肌酐清除率、合并用药(氨基糖苷类、阿昔洛韦、利巴韦林)、年龄≤3岁和入住ICU是莲必治注射液致儿童患者发生AKI的独立危险因素(P均<0.05)。所有AKI患儿经停药等处理,转归较好,无继发尿毒症发生。结论:高输液浓度、高日给药剂量、低内生肌酐清除率、合并用药(氨基糖苷类、阿昔洛韦、利巴韦林)、年龄≤3岁和入住ICU是莲必治注射液致儿童患者发生AKI的独立危险因素,临床使用莲必治注射液应重点关注有独立危险因素的患者,以保证莲必治注射液临床安全用药。

Risk Factors for Acute Kidney Injury Induced by Intravenous Infusion of Lianbizhi Injection in Children

Objective:To probe into the risk factors for acute kidney injury(AKI)induced by intravenous infusion of Lianbizhi injection in children,so as to provide clinical data for drug use.Methods:A retrospective study was performed,medical records of1,876 children who received Lianbizhi injection in our hospital from Jan.2016 to Mar.2018 were collected.According to the diagnostic criteria of AKI,there were 85 cases in AKI group and 1,791 cases in non-AKI group.The general data,primary disease,drug combination,application of Lianbizhi injection of two groups were compared.The risk factors for AKI were analyzed.Results:The incidence of AKI in children who used Lianbizhi injection in our hospital was 4.53%(85/1,876).Univariate analysis showed that there were statistically significant differences between two groups in age,proportion of admission to ICU,serum creatinine level,clearance rate of endogenous creatinine,drug combination(aminoglycosides,acyclovir,ribavirin,vasopressor and antudine),daily dose and infusion concentration(P<0.05).Further Logistic regression analysis showed that high infusion concentration,high daily dose,low clearance rate of endogenous creatinine,drug combination(aminoglycosides,aciclovir and ribavirin),age≤3 years and admission to ICU were independent risk factors of AKI induced by Lianbizhi injection in children(P<0.05).All children with AKI had better outcomes after drug withdrawal,and there was no secondary uremia occurred.Conclusion:High infusion concentration,high daily dose,low clearance rate of endogenous creatinine,drug combination(aminoglycosides,aciclovir,ribavirin),age≤3 years and admission to ICU were independent risk factors of AKI in children.In clinical practice of Lianbizhi injection,children with independent risk factors should be paid close attention to ensure the clinical application safety of Lianbizhi injection.