以急性肾损伤网络标准评估重症监护病房患者急性肾损伤的发病率、预后及死亡相关危险因素  

Use of the AKIN criteria to assess the incidence of acute renal injury, outcome and prognostic factors of ICU mortality in critically ill patients

作　　者：岳金凤[1] 吴大玮[1] 李琛[1] 翟茜[1] 陈晓梅[1] 丁士芳[1] 杜滨峰[1] 李远[1] 

机构地区：[1]山东大学齐鲁医院加强医疗科,济南 250012

出　　处：《中华医学杂志》2011年第4期260-264,共5页National Medical Journal of China

摘　　要：目的以急性肾损伤网络（AKIN）诊断标准分析入住综合重症监护病房（ICU）危重症患者急性肾损伤（AKI）的发病率和预后，并探讨影响患者ICU病死率的相关因素。方法回顾性分析2008年1月至2009年12月入住山东大学齐鲁医院综合ICU≥24h的544例患者临床资料，应用AKIN分级标准将患者分为4组（肾功能正常组、AKII期组、AKIⅡ期组和AKIm期组）。结果（1）544例患者中，符合AKI诊断标准191例（35．3％），其中AKII期组81例（14．8％），AKIlI期组45例（8．2％）、AKIm期组65例（11．9％）。（2）AKI（I＋Ⅱ＋Ⅲ期）组患者病死率明显高于肾功能正常组患者（48％比11％，OR=7．48，95％CI4．831～11．587，P〈0．001）。住ICU病死率随AKl分期加重而增加：AKII期组37％，AKIlI期组51％，AKIIU期组60％。（3）AKI各期均为影响ICU患者死亡的独立危险因素，其他的危险因素包括：原发病为内科疾病、感染性休克、多器官功能衰竭、存在慢性艰础疾病、APACHEⅡ评分、需要使用机械通气及肾脏替代治疗。结论AKI的发生和分期与患者临床预后密切相关，即使是轻度AKI患者病死率也明显高于肾功能正常组。AKIN标准对ICU患者发生AKI的早期诊断和判断预后有莆要的指导意义。Objective To evaluate the value of the AKIN criteria of acute kidney injury （AKI） in the incidence and prognoses in critically ill patients, and to further identify risk factors associated with the prognoses of the critically ill patients. Methods We retrospectively studied 544 adult patients hospitalized for≥ 24 h to a comprehensive ICU with 16 beds in teaching hospital from January 2008 to December 2009. Based on AKIN criteria, these patients were classified into four groups： NAKI （no AKI）, AKI Ⅰ , AKI Ⅱ, and AKIⅢ respectively. Results （ 1 ） Of the patients, 191 （ 35.5% ） fulfilled the criteria for AKI （14. 8% had AKI I 8.2% had AKI Ⅱ and 11.9% had AKI Ⅲ ）. （2）Mortality in the ICU was much higher in patients with AKI than in patients with no AKI（48% vs 11%, OR 7.48,95% CI 4. 831 -11. 587, P〈0. 001）. The mortality rate was 37% for AKI Ⅰ group, 51% for AKI Ⅱ group and 60% for AKIⅢ group. （3）In multivariate analysis, each AKIN category was independently associated with ICU mortality. The other independent risk factors for ICU mortality included internal medical diseases, septic shock, preexisting chronic illness, APACHE Ⅱscore, the number of failed organs, mechanical ventilation and CRRT. Conclusions The AKIN category closely relates to the prognoses in critically ill patients, even the mild degree of AKI with a much higher mortality rate than the patients without AKI. The AKIN criteria has some direction significance to the early detection and classification of AKI and to the prediction of clinical outcomes in critically ill patients.

关 键 词：重症监护病房 急性肾损伤 诊断标准 危险因素 预后 

分 类 号：R692[医药卫生—泌尿科学] R459.7[医药卫生—外科学]