重症患者医院获得性急性肾损伤的临床研究

Clinical study on hospital-acquired acute kidney injury of critically ill patients

目的探讨重症监护病房（ICU）医院获得性急性肾损伤（HA-AKI）的发病情况、易患因素和影响患者预后的因素。方法综合性ICU收治的2636例重症患者中出现HA-AKI251例，记录入院时和发生HA-AKI时患者的临床资料，并进行危重病评分；根据HA-AKI患者的预后分为治愈组、未愈组和死亡组，将治愈组和死亡组的各项参数进行比较。结果ICU中HA-AKI发生率为9．52％；出现HA-AKI时的血压、红细胞比容和血小板计数较入院时降低（P〈0．01），白细胞计数、血清总胆红素、中心静脉压、危重病评分均较入院时高（P〈0．01）。在出现AKI时，与治愈组比较，死亡组尿素氮、尿酸、血肌酐、危重病评分均较高（P〈0．05），使用机械通气治疗、出现休克和全身性炎症反应综合征（SIRS）者较多（P〈0．01，P〈0．05）。结论HA-AKI在重症患者中发生率较高，休克、有效循环血量不足和危重病评分高是常见的易患因素，血肌酐升高、休克、机械通气和SIRS等是影响HA-AKI预后的高危因素。

Objective To analyze the morbidity, susceptibility and prognosis of critically ill patients with hospital-acquired acute kidney injury （HA-AKI） in intensive care unit （ICU）. Methods 251 patients with HA-AKI were diagnosed from 2636 critically ill patients in general ICU, and the clinical data were recorded when hospitalization. Critical scores were also analyzed. According to the prognosis, these patients were divided into the death group, the cured group and the none-cured group. And the parameters of cured group were compared with those of death groups. Results The morbidity of HA-AKI in ICU was 9. 52%. The blood pressure,Hct and BPC at the moment of HA-AKI were lower, while WBC, serum total bilirubin, CVP and critical scores were higher than those on the admission to ICU （P〈0. 01 ）. At the moment of HA-AKI, blood urea nitrogen, urea acid, creatinine and critical scores were significantly higher in the death group than in the cured group （P〈0. 05）. The number of patients subject to mechanical ventilation and the incidence of shock or systemic inflammatory response syndrome （SIRS） in the death group were significantly increased as compared with the cured group （P 〈0. 01 or P〈0. 05）. Conclusions There is a higher morbidity of HA-AKI in critically ill patients. Shock, lack of effective circulating blood volume and higher critical scores are common predisposing factors of HA-AKI. Serum urea nitrogen, creatinine, shock, SIRS, mechanical ventilation, etc. are the risk factors that affect prognosis.