AKIN标准及RIFLE标准在严重感染者急性肾损伤中的诊断价值  

Comparison between the RIFLE and AKIN classifications in diagnosis of patients with acute kidney injure in intensive care unit

作　　者：黄文达 

机构地区：[1]深圳市龙华新区人民医院重症医学科,深圳市518109

出　　处：《中华实验和临床感染病杂志（电子版）》2015年第6期88-90,共3页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的对比AKIN及RIFLE标准在危重症患者急性肾损伤（AKI）中的诊断价值。方法选取2010年8月至2013年10月于本院就诊并入住ICU的发生严重感染和感染性休克的重症患者246例,根据患者血清肌酐、尿量的动态监测,分别采用AKIN标准和RIFLE标准进行诊断并分组,记录患者住院时间、ICU逗留时问以及病死率,评价不同标准对于重症患者急性肾损伤的诊断和预后判断能力。结果RIFLE和AKIN标准分别诊断出急性肾损伤患者77例平1199例,AKI发生率分别为31.30%和40.24%,组间对比发现AKI的发生率差异具有统计学意义（χ^2=4.282,P=0.039）,而对急性肾损伤早期的诊断中,AKIN标准的诊断率（17.07%）与RIFLE标准（9.35%）相比显著升高;两种标准诊断的AKI组患者的病死率较NAKI组显著升高,而RIFLE和AKrN标准诊断的AKI患者病死率差异无统计学意义（χ^2=0.107,P=0.743）。结论AKIN标准显著提高了对于AKI诊断的灵敏度,尤其对于早期AKI的诊断;但对于AKI的预后判断能力并未改善。Objective To evaluate the value in diagnosis of acute kidney injury（AKI） comparatively between RIFLE and AKIN classifications of patients in intensive care unit.Methods Total of 246 cases with severe septic and septic shock were selected in Intensive Care Unit of our hospital from August 2010 to October 2013,according to dynamic monitoring of the serum creatinine and urine,the RIFLE and AKIN classifications were used to define and diagnose acute kidney injury and then grouped.The hospitalization time,ICU stay time,mortality were recorded and the different classification in diagnosis and prognosis capabilities were evaluated,respectively.Results There were 77 cases and 99 cases diagnosed by RIFLE and AKIN classification,respectively,the incidence rates of AKI were 31.30%and 40.24%.There was significant difference in the incidence rates of AKI between the two groups（χ^2=4.282,P=0.039）,while in the early diagnosis of acute kidney injury,compared with RIFLE classifications（9.35%）,the diagnosis rate of AKIN classifications（17.07%） increased significantly.The mortality of patients in AKI group was significantly higher than that of the NAKI group,and there was no significant differences in the mortality of patients with AKI diagnosed by RIFLE and AKIN classifications（χ^2=0.107,P=0.743）.Conclusions AKIN classification significantly improved its sensitivity for the diagnosis of AKI,especially for the early diagnosis of AKI,without improvement of the prognostic ability.

关 键 词：急性肾损伤 风险期、损伤期、衰竭期、丧失期和终末期肾病标准 急性肾损伤网络工作小组标准 诊断 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]