重症监护病房住院患者急性肾损伤的发病及预后分析  

Analysis of incidence and prognosis in ICU hospitalized patients with acute kidney injury

作　　者：王永芳[1] 彭媛[1] 王晓艳[1] 杨润[1] 

机构地区：[1]昆山市第一人民医院重症医学科,江苏昆山215300

出　　处：《临床荟萃》2014年第11期1250-1253,共4页Clinical Focus

摘　　要：目的：分析重症监护病房（ICU）住院患者并发急性肾功能损伤（AKI）的发病及影响预后的危险因素,为临床更好的预防AKI的发生、改善预后提供依据。方法调查本院2010年1月至2013年12月所有ICU住院患者1100例,以急性肾损伤网（AKIN）推荐的AKI定义筛选出病史完整的AKI患者105例,回顾性分析AKI患者的一般临床资料、病因、临床特点,采用logistic回归分析影响其预后的危险因素。结果符合入选标准的住院AKI患者105例,肾前性、肾性、肾后性AKI分别占71.4%、23.8%、4.8%,肾前性病因中,脓毒症是ICU患者AKI发生的最主要的原因（占45.0%）,随着AKI程度的增加,AKI患者ICU住院时间明显延长（F=3.450,P〈0.05）,28天病死率亦明显增高（χ2=16.500,P〈0.01）。应用多因素logistic逐步回归分析法显示AKI患者基础疾病的严重程度[相对比值比（OR）=3.259,95%可信区间（95%CI）=1.453-5.087,P〈0.01]、肾外器官衰竭数（OR=1.275,95%CI=1.071-1.421,P〈0.01）、年龄（OR=2.315,95%CI=1.015-3.684,P〈0.01）、行肾替代（CRRT）治疗与否（OR=2.018,95%CI=1.852-3.014,P〈0.01）是AKI患者肾功能未恢复的独立危险因素。结论AKI是ICU住院患者的常见并发症之一。脓毒症是住院AKI最常见的原因。合并严重基础疾病、肾外器官衰竭、年龄、行CRRT治疗与否是AKI患者肾功能未恢复的独立危险因素。Objective To investigate the incidence and prognosis of acute kidney injury（AKI）in critically ill patients,and to further identify risk factors associated with the prognosis of the critically ill patients in order to help clincians better understand and prevent AKI.Methods All patients hospialized in the intensive care unit（ICU）of the hospital of Kun-shan during January of 2011 to December of 2013 were screened.Study group was comprised of the patients with full clinical data of AKI,as defined by Acute Kidney Injury Network（AKIN）.The clinical characteristics and the etiology of hospitalized patients with AKI were retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors of the prognosis in patients with AKI.Results One hundred and five patients suffering from AKI were enrolled.Analysis of the causes of AKI showed that pre-AKI accounted for 71.4%,followed by renal parenchyma AKI（23.8%）and postrenal AKI（4.76%）.The most common reason for AKI was sepsis（45.0%）.The higher severity the AKI,the longer the time staying in the ICU（F = 3.450,P 〈 0.05 ）and the higher the 28 day mortality（χ2 = 1 6.500,P 〈 0.01 ）.Multivariate logistic regression analysis showed that the severity of acute basic diseases（OR =3.259,95% CI =1.453-5.087,P 〈0.01）,failure of organs other than kidney （OR =1.275,95% CI =1.071-1.421,P 〈 0.01 ）,age （OR = 2.31 5,95% CI = 1.01 5-3.684,P 〈 0.01 ）and requiring continuous renal replacement therapy（CRRT）（OR = 2.018,95% CI = 1.852-3.014,P 〈 0.01 ）were independent risk factors for unrecovered renal function.Conclusion AKI is one of the most common complications in critical ill patients in ICU. Sepsis is the most common reason for AKI.The severity of acute basic diseases,the number of failure organs except kidney,age and requiring CRRT are independent risk factors for unrecovered renal function.

关 键 词：急性肾损伤 重症监护病房 危险因素 预后 

分 类 号：R692[医药卫生—泌尿科学]