Study Of The Relative Factors Of Acute Cerebrovascular Disease Complicated By Acute Kidney Injury

Acute cerebrovascular disease (ACVD) is a common and frequently-occurring disease.It's a serious threat to human health and has negative impact on patient quality of life.The disability rate and mortality of ACVD are both high. If given active and effective treatment, there would be positive clinical significance.The patients ill with ACVD not only exist nervous system diseases(such as cerebral hemorrhage, cerebral infarction and subarachnoid hemorrhage, etc.),but also can result in complications of the other systems or organs.The common complications of ACVD includes cerebral hernia, brain-heart syndrome,pulmonary embolism, pneumonia, upper gastrointestinal bleeding,acute pyelonephritis, and bedsore, etc.. In this study,we observed that the patients collected in clinic and emergency without kidney disease before ACVD who had been found the incidence of kidney damage after the ACVD is also not uncommon, but it hasn't been paid enough attention,and the studies in this respect are rarely reported. At the same time, once ACVD complicated AKI,the occurred ACVD would be worse, and would have negative impact on the other systems and organs. Therefore, it is necessary to pay enough attention to ACVD complicated by AKI.not only the patient's overall function and general status will The definition of AKI was put forward by the experts in kidney disease and critically ill both at home and abroad combined with Acute Dialysis Quality Initiative(ADQI) advocacy of"acute kidney injury(AKI)"commonly used to replace the traditional"acute renal failure (ARF)"in recent years.In september, 2005 , experts including including ADQI members held a meeting in Amsterdam,get the definition (diagnostic criteria) of AKI : from a variety of reasons led to changes in structure or function of the kidney damage caused the renal function of a sudden (48 hours) decreased, showing an increase of Scr absolute value≥0.3mg/dl (≥26.4umol / L), or an increase value≥50% (to reach 1.5 times the baseline value), or the urine volume <0.5ml / ( kg ? h) sustained more than 6 hours. The new definition of AKI and the more accurate diagnosis and clinical classification criteria may provide the possibility and basis for early detection and prevention and treatment in a timely manner the occurrence of kidney damage and to maximize the restoration of renal function reversal.After ACVD occurred, a considerable portion of patients without original kidney disease or renal dysfunction had the emergence of new clinical symptoms of renal damage and abnormal test indexes . It may be a reversible transient process early in the incidence of kidney damage, but if it hadn't been found or treated in time, the kidney damage may be rapidly deteriorate, once it run to AKI, even ARF, it would have seriously affect on the therapeutic effect and prognosis of the patient with ACVD. Therefore,it should be attached importance to ACVD complicated by AKI,the early detection,timely intervention and proper control measures would take on positive clinical significance. Although up to present the related studies or experiments are few, and the specific mechanism of pathogenesis is not yet clear, but through a number of retrospective analysis of the research combined with actual clinical data ,it's helpful to find out the pathogenesis and the risk factors of ACVD complicated by AKI,thereby guiding clinical treatment of the patients with ACVD.Objective:To discuss and analyse the relative factors, effective preventions and interventions of ACVD complicated by AKI,in order to provide some theoretic referrence and guidance on early detection ,proper treatment of the patient of ACVD complicated by AKI in clinical,accordingly help to decrease the morbidity of this kind of disease and improve its survival rate and prognosis.Methods:Collected 126 cases of patients with ACVD but without AKI before hospitalized to the emergency room or clinic room of our hospital in the past tow years. Hospital-in patients with ACVD were given system conventional neurological treatment, for the patients with ACVD complicated by AKI, once discovered it's occurence,given conventional medical treatment of AKI immediately .Tested renal function, serum ions,urine routine and other ralated tests instantly after the selected patients hospital-in, and began to monitor urine volumand ,observe the treatment results and prognosis.The first hospital-in 48 hours tested renal function and serum ions once a day,gave the patients of normal renal function a review test on the tertian day;gave the patients of abnormal renal function a continuous daily monitoring once a day. According to AKI diagnostic criteria: Scr absolute value increase≥0.3mg/dl (≥26.4umol / L), or an increase≥50% (to reach 1.5 times the baseline value), or urine volume <0.5ml / (kg ? h) last more than 6 hours, the selected patients was divided into two groups: study group (concurrent AKI group) and the control group (non-concurrent AKI group), and then analysed and compared the clinical data of the patients in the two groups (morbidity, mortality and prognosis, as well as gender, age,hypertension history, diabetes history, history of hyperlipidemia, the conditionof brain lesions and the use of nephrotoxic drugs, etc.).Result: The morbility of the ACVD complicated by AKI group was (41/126)32.54% , in which the number of the cerebral hemorrhage with AKI was 29 ,accounting 70.73% of the total, the number of cerebral infarction with AKI was 12 ,accounting 29.27% of the total.The death rate of the study group was 24.39%,7 cases died of cerebral hemorrhage,3 cases deid of massive cerebral infarction; The death rate of the contrast group was 5.88%,4 cases died of cerebral hemorrhage,1 cases deid of cerebral infraction.The death rate of the study group was higher than the contrast group (p<0.01). The rates of the old(≥60 years)patients, being accompanied by hypertension ,diabetes , hyperlipidemia ,cerebral hemorrhage, the brain lesion located in thalamus,big lesion and using large dose mannitoland cephalosporin or aminoglycoside antibiotics of the study group were was higher than the contrast group(p<0.05).Conclusion: 1.Patients with ACVD were prone to complicated by AKI, especially in the cases of cerebral hemorrhage. The mortality of the patient with ACVD complicated by AKI was significantly higher than the patient not complicated with AKI, and the former group had a poor prognosis.The occurrence of ACVD complicated by AKI had adverse effects on the treatment and prognosis of primary ACVD.It should be paid sufficient attention.2.SCr and urine volum can be used as early referenced indexes of the clinical diagnosis of ACVD complicated by AKI. 3. The occurrence of ACVD complicated by AKI were not only related to gender (male), age(≥60 years old) and primary existing disease (including hypertension, diabetes, hyperlipidemia, etc.), but also associated with the other factors,such as the nature of the brain lesion (especially cerebral hemorrhage), location ( particularly located in thalamus), the severity of the brain lesiona(eg.the big hemorrhage volume and the massive infraction area) and the use of nephrotoxicity (such as large dose mannitoland cephalosporin or aminoglycoside antibiotics),ect..4.It's neccesary to attach importance to the above-mentioned factors in clinical ralated to ACVD complicated by AKI,and to give closely monitoring and effective intervention to prevent the occurrence of AKI;for the patient with high risk factors of ACVD complicated by AKI, more attention should be paid. If AKI was unavoidable to occur , AKI should be found as soon as possible,and be given targeted intervention and treatment, in order to get the maximum extent possible to reverse AKI and protect the kidney, thereby improving the survival rate and the prognosis of the patient.