基于RIFLE标准急性肾损伤患者发病率及病死率的研究  

The study of morbidity and mortality of acute kidney injury with the diagnosis criteria of RIFLE

作　　者：王海霞 郑瑞强 林华 於江泉 

机构地区：[1]苏北人民医院ICU,江苏省扬州225001

出　　处：《中华急诊医学杂志》2013年第3期276-279,共4页Chinese Journal of Emergency Medicine

基　　金：江苏省333高层次人才培养工程基金资助（2007-58）

摘　　要：目的以RIFLE诊断标准分析人住重症医学科（ICU）患者急性肾损伤（AKI）的发病率和预后，并探讨影响其发病率和病死率的相关因素。方法回顾性分析2008年1月至2011年6月入住苏北人民医院ICU患者临床资料，应用RIFLE分级标准将患者分为4组：肾功能正常组、R（risk）组、I（injury）组和F（failure）组，记录患者一般情况、基础疾病、入住ICU的主要原因，分析导致AKI的病因和影响病死率的危险因素。结果（1）2472例患者中，符合AKI诊断的404例（16．3％），AKI的年龄为（61．4±17．4）岁。导致AKI的病因包括感染、肺部疾病、中枢系统疾病及创伤。（2）AKI患者病死率明显高于肾功能正常组患者（47．3％ vs ．23％，P〈0．05）。ICU病死率随RIFLE分级加重而增加：R组35．6％，I组48．9％，F组60．6％。（3）Logistic回归分析显示AKI合并有MODS及感染性休克是影响预后的危险因素，而CRRT（连续肾脏替代疗法）为影响预后的独立保护因素。结论AKI明显增加ICU患者的病死率，RIFLE标准是诊断和预测预后的有效工具。Objective To evaluate the value of the RIFLE criteria of acute kidney injury （AKI） for predicting the incidence and prognosis in critically ill patients and to identify the risk factors associated with the outcomes of those patients. Methods All ICU patients admitted over three years and 6-month period were retrospectively studied at Subei People＇s Hospital. Based on RIFLE criteria, AKI patients were diagnosed and classified into four groups： NAKI （non-AKI）, R （risk）, I （injury）, F （failure） groups. Results （ 1 ） AKI occurred in 404 of the 2472 patients （ 16. 3% ） during their ICU stay. The mean age of the patients was （61.4 ± 17.4） years. Infectious disease, pulmonary disease, neurological disease and trauma were the major cause of AKI. （2） Mortality in the ICU was much higher in patients with AKI than in patients without AKI （47.3% vs. 23.0%, P 〈 0. 05）. The mortality rate was 35.6% in R group, 48.9% in I group and 60. 6% in F group. （ 3 ） The logistic regression suggested that MODS and septic shock were the independent risk factors of AKI, but continuous renal replacement therapy （CRRT） are the independent protective factor of AKI. Conclusions In these ICU patients, AKI is associated with increased hospital mortality. The RIFLE classification is a simple and useful diagnosis tool to detect and stratify the severity of AKI and aid in predicting outcome of patients.

关 键 词：急性肾损伤 RIFLE标准 危险因素 预后 

分 类 号：R692[医药卫生—泌尿科学]