中国住院成人患者围手术期急性肾损伤的流行病学及临床特点  

Epidemiological and clinical characteristics of perioperative acute kidney injury in hospitalized adult patients in China

作　　者：卢涛 聂晟[2] 汪永平[2] 王国保[2] LU Tao;NIE Sheng;WANG Yongping(Department of Nephrology,Changzhou Seventh People’s Hospital,Changzhou 213000,CHINA)

机构地区：[1]常州市第七人民医院肾内科,江苏213000 [2]广东省南方医科大学南方医院肾内科(国家肾脏病临床研究中心)

出　　处：《江苏医药》2019年第9期920-925,共6页Jiangsu Medical Journal

基　　金：广州重大科技计划项目(15020010);广州市慢性肾病临床研究中心项目(7415695988305)

摘　　要：目的探讨中国住院成人患者围手术期急性肾损伤(AKI)的发生情况。方法多中心队列研究共纳入住院手术成人患者68207例。排除慢性肾脏病(CKD)4~5期、维持透析和肾移植患者。分析术前2d~术后1周发生AKI的临床特征和危险因素,计算住院死亡率。结果全组患者围手术期AKI的发生率为6.9%。心脏手术围手术期AKI的发生率最高(32.7%),其次是血管外科手术(17.4%)和泌尿外科手术(12.1%)。围手术期AKI在术后第1天最为常见。多因素分析显示,年龄、基础CKD、心力衰竭、肝脏疾病和实体肿瘤是围手术期AKI的独立预测因素(P<0.01)。与围手术期未发生AKI患者相比,围手术期AKI患者住院死亡率升高(P<0.01)。≥80岁围手术期AKI患者较其他年龄组死亡率高(P<0.05);但≥80岁AKI1期和3期患者肾功能恢复率与其他年龄组比较无统计学差异(P>0.05)。结论围手术期AKI多发生在术后第1天。心血管和泌尿外科高龄手术患者容易发生围手术期AKI,且与较高的住院死亡率相关。Objective To investigate the occurrence of perioperative acute kidney injury(AKI) in hospitalized adult patients in China.Methods A total of 68 207 adult hospitalized patients undergoing surgeries from multicenter cohort study in China was investigated.The patients with stage 4-5 chronic kidney disease(CKD)and those receiving maintenance dialysis or renal transplantation were excluded.The clinical characteristics and risk factors for AKI occurred in a period of 2 days before operation to one week after operation were analyzed.The inhospital mortality of the patients with perioperative AKI was calculated.Results The incidence of perioperative AKI was 6.9% in 68 207 adult hospitalized patients,which was 32.7% for the patients undergoing cardiac surgery and 12.1% for the patients undergoing urologic operation.The perioperative AKI occurred most commonly on the first day after operation.Multivariate analysis showed that age,basic CKD,heart failure,liver disease and solid tumor were the independent predictors of perioperative AKI(P<0.01). Compared with non-perioperative AKI patients,the mortality of perioperative AKI patients was increased(P<0.01).In the patients with perioperative AKI,the mortality of the patients over 80years old was higher than that of other age groups(P<0.05).But in the patients with AKI stage 1and 3,there was no significant difference in the recovery rate of renal function between the patients over 80 years old and other age groups(P>0.05).Conclusion Most of the perioperative AKI occur on the first day after operation.The patients undergoing cardiovascular and urologic surgery are more prone to occur perioperative AKI and with higher inhospital mortality.

关 键 词：围手术期急性肾损伤 流行病学 

分 类 号：R619[医药卫生—外科学]