中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (01): 14-19.doi: 10.3969/j.issn.1671-4091.2017.01.005

• 临床研究 • 上一篇    下一篇

急性肾损伤住院患者的临床研究

薛瑾虹1,刘华1,史珂慧1,何荃1,魏萌1,王萌1,孙凌霜1   

  1. 1 西安交通大学第一附属医院血液净化科
  • 收稿日期:2016-05-25 修回日期:2016-10-10 出版日期:2017-01-12 发布日期:2017-01-12

Analysis of hospitalized patients with acute kidney injury

  • Received:2016-05-25 Revised:2016-10-10 Online:2017-01-12 Published:2017-01-12

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摘要： 目的通过回顾性分析我院住院患者急性肾损伤(acute kidney injury，AKI)的发生率、病死率、病因构成、加重住院患者AKI 程度及影响临床转归的危险因素，为临床更好地认识、预防、早期干预AKI 提供依据。方法回顾性分析西安交通大学第一附属医院2012 年7 月～2014 年6 月期间所有住院患者，以2012 年KDIGO 指南推荐的AKI 的定义为标准，筛选出病史完整的AKI 患者，记录患者一般情况、实验室检查数据、基础疾病、病因、分布情况、预后等，分别用Logistic 回归分析AKI 死亡及早期AKI 发展为中、重度AKI 的独立危险因素。结果观察期间129 624 住院患者，其中727 人发生AKI，发生率为0.561%，其中AKIⅠ、Ⅱ、Ⅲ期发生率分别为28.198%(205/727)、31.627%(230/727)、40.165%(292/727)；病死率26.135%；医院获得性AKI 为153 例(21.045%)；多因素Logstic 回归分析：多器官功能衰竭(OR=4.328，95% CI 2.643～7.087，P＜0.001)、老龄(OR=1.523，95% CI 1.023～2.267，P=0.038)、肝炎肝硬化(OR=3.321，95% CI 1.724～6.397, P＜0.001)、恶性肿瘤(OR=2.044，95% CI 1.187～3.518，P=0.01)为AKI 患者死亡的独立危险因素。多器官功能衰竭(OR=2.314，95% CI 1.550～3.455，P＜0.001)、出血热(OR=2.205，95% CI 1.124～4.325，P=0.021)为AKI 早期发展至中晚期的独立危险因素。结论AKI 为临床常见综合征，发生率、病死率高。多器官功能衰竭、老龄、肝炎肝硬化、恶性肿瘤、出血热严重影响AKI 的预后。医护人员认知水平的提高、动态监测肾功能是AKI早期诊断的关键。

关键词: 急性肾损伤, 病死率, 病因, 住院患者, 危险因素

Abstract: Objectives To improve the treatment and prognosis of AKI patients, we retrospectively analyzed the mortality, incidence rate, etiology, prognosis, and risk factors for mortality and severity of acute kidney injury (AKI) in hospitalized patients. Methods We analyzed the hospitalized patients treated in the First
Affiliated Hospital of Xi’an Jiaotong University during July 2012 to June 2014, and used the KDIGO clinical practice guideline for AKI as the criterion for the diagnosis of AKI to pick out AKI patients. Their clinical features, general information, laboratory data and prognosis were then collected. Logistic regression was conducted to investigate the risk factors for mortality and severity of AKI patients. Results There were 129,624 hospitalized patients during this study period, and 727 of them were diagnosed as AKI. The overall incidence of AKI was 0.561%, and the mortality of AKI was 26.135%. The ratios of stage I, II and Ⅲ AKI were 28.198%, 31.637%, and 40.165% respectively in these AKI patients, and the mortality rates in stage I, II and Ⅲ AKI were 9.268%, 30.000% and 34.932% respectively (P＜0.001). Hospital-acquired AKI was diagnosed in 153 patients (21.045% ). Multivariate logistic regression showed that multiple organ dysfunction syndrome (MODS) (OR=4.328, 95% CI 2.643～7.087, P＜0.001), older age (OR=1.523, 95% CI 1.023～2.267, P= 0.038), hepatic cirrhosis (OR= 3.321, 95% CI 1.724～6.397, P＜0.001), cancer (OR=2.044, 95% CI 1.187～3.518, P=0.01) were the independent risk factors for death, and that MODS (OR= 2.314, 95% CI 1.550～3.455, P＜0.001) and epidemic hemorrhagic fever (OR=2.205, 95% CI 1.124～4.325, P=0.021) were the independent risk factors for stage II and Ⅲ AKI. Conclusions AKI is a clinical syndrome with higher incidence and mortality. MODS, older age, hepatic cirrhosis, cancer, and epidemic hemorrhagic fever were the factors seriously affecting the prognosis of AKI. For early detection of AKI, we should keep awareness of the presence of AKI and frequently monitor renal function in related patients.

Key words: Acute kidney Injury, mortality, cause, hospitalized patient, risk factor