重症监护病房患者急性肾损伤的临床调查

Survey of acute kidney injury in intensive care unit

目的了解重症监护病房(ICU)患者急性肾损伤(AKI)的发生率、病死率,筛选AKI致病危险因素。方法回顾性分析2009年8月至2010年8月住辽宁省人民医院ICU患者的临床资料,除外在ICU时间<24小时的患者和再次入住ICU的患者,除外既往就有慢性肾功能不全的患者以及进行肾脏手术的患者和资料不完整者。将入选的316例患者按AKI网络(AKIN)标准分为无AKI组和AKI组(分为危险组,损伤组和衰竭组),通过t检验和χ2检验进行两组间变量的差异比较,再用logistic回归分析筛选出AKI的危险因素。结果在入选的316例患者中有109例患者发生AKI,发病率是34.5%(其中危险组、损伤组和衰竭组的发病率分别是21.2%、9.8%和3.5%),ICU患者住院病死率是25.9%(82/316),无AKI组是11.1%,AKI组是54.1%,其中危险组是46.3%,损伤组是58.1%,衰竭组是90.9%(P<0.005),AKI显著增加了ICU患者的住院病死率。Logistic回归分析显示机械通气和脓毒性休克是AKI的独立致病危险因素。结论 ICU患者AKI发病率高,AKI显著增加了ICU患者的病死率,机械通气和脓毒性休克显著增加了ICU患者AKI的发病率,是AKI的独立危险因素。

Objective To evaluate the occurrence of acute kidney injury（AKI） using the AKI net（AKIN） classification,to define risk factors and hospital mortality associated with AKI. Methods We performed a retrospective study of all ICU patients over a year period at the People＇s Hospital of Liaoning. AKI was evaluated according to the AKIN classification （increasing severity classes risk,injury, and failure）. The patients who stayed less than 24 hours in ICU,or re-hospitalized, those with chronic renal inadequacy in the past or kidney surgery or incomplete data were excluded. The enrolled 316 cases were divided into two groups, non-AKI group,and AKI group, subdivision including risk group（AKIN-R）, injury group（AKIN-I）, and failure group（AKIN-F）. First, univariate analysis was used to screen the variables related to prognosis,odds ratios（ OR ） and 95% confidence interval（ CI ） were calculated,then multiplefactor analysis was proceeded with logistic regression among the variables. Results AKI occurred in 109 of the enrolled 316 patients （34.5%） during their ICU stay, with AKIN-R, AKIN-I, and AKIN-F in 21.2%, 9.8%, and 3.5%, respectively. The overall mortality among the patients studied was 25.9 % （82/316）. The hospital mortality was 11.1 for non-AKI patients,46.3 % for risk patients, 58.1% for injury patients, and 90.9 % for failure patients （ P 〈0. 005）. The hospital mortality was 54.1% for AKI patients. Cumulative mortality rates differed significantly for non-AKI versus AKI patients （ P 〈0.01）. AKI was associated with elevated mortality,compared with non-AKI（ P 〈0.01）. In univariate analysis,mechanical ventilation and septic shock were the independent risk factors for AKI. Conclusion In these ICU patients, AKI is a common and serious complication which associates with increased hospital mortality. Mechanical ventilation and septic shock are significantly associated with increased occurrence of AKI.