单中心住院患者急性肾损伤临床特点的分析  

Clinical features of acute kidney injury in single center in-patients

作　　者：危志强[1] 曹娟[1] 李海涛[1] 许琴[1] 印荻[1] 周长菊[1] 章旭[1] 

机构地区：[1]江苏省泰兴市人民医院肾内科泰州市肾脏病临床研究中心,225400

出　　处：《临床肾脏病杂志》2017年第3期168-171,共4页Journal Of Clinical Nephrology

摘　　要：目的了解江苏省泰兴市人民医院成年住院患者(年龄>18岁)急性肾损伤(acute kidney injury,AKI)的流行病学、病因构成、临床诊治情况及预后,为该疾病防治提供依据。方法通过调查2013年3月及2013年7月泰兴市人民医院住院患者,根据国际肾脏病学会(International society of Nephrology,ISN)-AKF"0 by 25"的筛选标准,筛检出AKI患者,进行横断面调查。结果观察期间共有住院患者7 313例次,其中148例患者存在AKI,发病率为2.0%,其中院外获得AKI 61例,院内获得AKI 87例;总病死率为0.3%,其中AKI病死率为13.6%。老年93例(占62.8%)。仅有5例(3.4%)患者在肾脏内科就诊。肾前性因素(60.8%)及肾性因素(27.0%)是导致AKI发生的主要原因,肾性因素方面,以感染(27.7%)和药物(37.7%)为主。能及时正确诊断者57例(38.5%),漏诊81例(54.7%),延误诊断者10例(6.8%)。仅12例(8.1%)患者请肾脏科会诊。病情平稳出院仅有88例(59.5%),60例(40.5%)死亡或放弃治疗出院。在随访1年中,10例失访,死亡35例(39.8%)。Logistic回归分析提示,影响预后的危险因素为:年龄(OR=5.409,95%可信区间:2.203~39.256)、合并多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)(OR=16.352,95%可信区间:5.291~86.256)和感染(OR=12.354,95%可信区间:3.2651~66.128)。结论 AKI在泰兴市人民医院住院患者中发病率高,病死率高,关注度低,临床以老年、存在基础疾病及使用肾脏损害药物的人群为主,多分布在肾脏内科以外的临床科室,大部分AKI患者未获得专科医师的诊疗指导,年龄、合并MODS和感染为影响死亡的危险因素,总体预后较差。Objective To investigate the epidemiology, etiology, clinical diagnosis and treatment of acute kidney injury （AKI） in adult patients, in Taixing People＇s Hospital of J iangsu Province, to provide a basis for the prevention and treatment of AKI. Methods A cross-sectional study was conducted on AKI patients, according to the screening criteria of International society of Nephrology （ISN）-AKF ＂0 by 25＂, admitted to this hospital from March 2013 to July 2013. Results 148 patients, including 61 cases out of hospital and 87 cases in hospital respectively, were diagnosed as having AKI （2. 0%）. The total mortality rate was 0. 3%, and the mortality rate of AKI was 13.6%. The old pa- tients accounted for 62. 8%. Only 3. 4% patients suffered from AKI were treated in Department of Nephrology. Prerenal fators （60. 8%） and renal factors （27. 0%） as the main factors caused AKI. Meanwhile, infection （27. 7%） and drug （37. 7%） were main renal factors. Only 38. 5% patients were diagnosed timely, 54. 7% were missed, while 6.80/oo were delayed. 8. 1% patients got consultation. There were only 59. 5% discharged from hospital, and 40. 5% died or abandoned. After one-year follow-up, 10 patients lost to follow-up and 39. 8% patients died （41.2%）. Logistic regression analy sis showed that age （OR = 5. 409, 95% CI： 2. 203-39. 256）, multiple organ dysfunction syndrome （MODS） （OR = 16. 352, 95% CI： 5. 291-86. 256） and infection （OR = 12. 354, 95% CI： 3. 2651-66. 128） were risk factors for prognosis. Conclusions The incidence and mortality of AKI in inpatients are high, especially in elderly patients and those with basic diseases and given renal toxicity drugs. These patients are mainly distributed in clinical departments apart from the department of nephrology, and most of them did not receive specialist diagnosis and treatment guidance. Age, combined MODS and infection are risk factors for the death of AKI patients, and the overall prognosis is poor.

关 键 词：急性肾损伤 流行病学 临床特点 

分 类 号：R692[医药卫生—泌尿科学]