急诊重症监护室急性肾功能损伤患者的临床特征及预后分析  

Clinical characteristics and prognosis of patients with acute kidney injury in emergency intensive care unit

作　　者：王娜[1] 李培兰[1] Wang Na;Li Peilan(Department of Emergency,China Rehabilitation Research Center,Capital Medical University,Beijing 100068,China)

机构地区：[1]首都医科大学附属中国康复研究中心北京博爱医院急诊科,北京100068

出　　处：《临床荟萃》2018年第4期319-322,328,共5页Clinical Focus

基　　金：中国康复研究中心课题(2012-32)

摘　　要：目的研究急诊重症监护室(EICU)急性肾功能损伤(AKI)患者的发病率,比较脓毒症AKI患者和非脓毒症AKI患者的临床特征,并进一步探讨AKI患者的预后。方法 2014年1月至2016年12月连续纳入335例EICU患者,将AKI患者分为脓毒症AKI组与非脓毒症AKI组,比较两组基础的临床特征及实验室检查结果。AKI患者依据KDIGO(Kidney Disease:Improving Global Outcomes)诊断标准进行分级并进行生存分析。结果 335例患者中175例发生了AKI。其中脓毒症AKI患者114例,非脓毒症AKI患者61例。与非脓毒症AKI患者比较,脓毒症AKI患者危重病评分更高,更多使用了血管活性药物和机械通气,AKI分级更差,28天病死率更高。多元回归分析显示,感染、序贯器官衰竭评分(SOFA)、利尿剂和合并冠心病是AKI发生的危险因素。感染、休克、AKI分级是AKI患者28天死亡的危险因素。结论 EICU中AKI的发病率和病死率均较高,脓毒症AKI患者比非脓毒症AKI患者的预后更差。AKI的发生及预后与多种因素有关。Objective To analyze the incidence and prognosis of patients with acute kidney injury(AKI)in emergency intensive care unit(EICU)and to compare the clinical characteristics of patients with sepsis and nonsepsis and explore the prognosis of patints with AKI.Methods This study analyzed the baseline characteristics and laboratory data of 335 patients in EICU from January 1,2014 to October 31,2016.AKI patients were allocated into AKI+sepsis group and AKI-sepsis group for analysis of clinical characteristics.The AKI severity was classified according to the KDIGO(Kidney Disease:Improving Global Outcomes)guidelines.The multivariable Logistic regression was applied to investigate risk factors for the progression and death of AKI.Results Of 335 patients,175 cases(52.2%)developed AKI.Among them,there were 114 cases of septic AKI patients and 61 cases of nonseptic AKI patients.Patients with septic AKI had higher illness severity scores than nonseptic AKI patients,Vasoactive therapy and mechanical ventilation were used more commonly in septic AKI patients.The multivariable Logistic regression analysis revealed that the development of AKI was associated with infection,SOFA score,use of diuretics and cardiovascular.Infection,shock and the severity of AKI were identified as the risk factors for 28-day mortality.Conclusion AKI patients have high morbidity and mortality in EICU,while patients with septic AKI had a worse prognosis than nonseptic AKI patients.A variety of factors are related to the prognosis of AKI.

关 键 词：肾疾病 肾功能试验 脓毒症 临床特征 预后 

分 类 号：R692[医药卫生—泌尿科学]