住院患者急性肾损伤流行情况的单中心研究

Clinical epidemiology analysis of acute kidney injury in hospitalized patients in a single center

目的了解广西医科大学第一附属医院住院患者急性肾损伤（acute kidney injury，AKI）的发病率、病因构成及预后，为该疾病的诊治及预防提供依据。方法通过调查2011年3月至2011年8月广西医科大学第一附属医院住院患者的肾功能检测结果，并结合有无少尿情况，筛检出急性肾损伤患者，进行横断面调查，研究其病历、临床特征及辅助检查结果。结果观察期间共有住院患者28291例次，其中141例患者住院期间发生急性肾损伤，发病率为0．5％。观察期间住院患者总病死率为0．78％，其中急性肾损伤患者病死率为19．86％。肾性因素（占急性肾损伤52．48％）是导致急性肾损伤发生的首要原因，其中感染（占急性肾损伤18．44％）和药物（占急性肾损伤16．31％）为主。手术相关性因素（占医院获得性急性肾损伤35．48％）尤其是心脏及血管手术（占医院获得性急性肾损伤25．81％）造成医院获得性急性肾损伤尤为明显。Logistic回归分析结果表明，影响急性肾损伤病死率的因素是合并多器官功能不全综合征，OR值为17．379，影响治愈率的因素是医院获得性急性肾损伤，0R值0．331。结论住院患者急性肾损伤的发病较常见，病死率高。肾性因素是急性肾损伤的首要病因，感染和药物是肾性急性肾损伤的主要病因。手术相关性因素特别心血管手术造成医院获得性急性肾损伤尤其明显。多器官功能不全综合征是急性。肾损伤患者死亡的危险因素。医院获得性因素是影响急性肾损伤患者治愈的因素。

Objective To investigate the incidence, etiology and the prognosis of acute kidney injury（AKI） among hospitalized patients in First Affiliated Hospital of Guangxi Medical University, and provide a basis for the prevention and treatment of diseases. Methods Patients who were admitted in the First Affiliated Hospital of Guangxi Medical University from March 2011 to August 2011 were involved. After checking the computer-based data on kidney function, combined with the presence of ol- iguria, patients with acute kidney injury were picked out and further history reviews were demanded to get the information of clinical characteristics and laboratory examination. Results There were 28 291 admissions during the study period and 141 met with the diagnostic criteria of acute kidney injury （AKI）. The morbidity of AKI was 0. 50~//00. In-hospital mortality was 0. 78% in all discharges while 19. 86% in patients with AKI. And infection （18. 440//00 in AKI） and drugs （16. 31% in AKI） were the main causes of renal AKI （52. 480//oo in AKI）. The operation was 35. 48~ in HA-AKI, and the opera- tion of heart and vessel （25.81 ~ in HA-AKI） was especially apparent. The results of logistic regres- sion analysis suggested the multiple organ dysfunctional syndrome（OR 17. 379） was the risk factor of death among AKI patients. And the result of logistic regression analysis suggested the hospital-ac- quired（OR 0. 331） was the influence factor of cure rate. Conclusions Acute kidney Injury is prevalent in hospitalized patients, and the mortality of AKI is high. The renal factor is the main cause of AKI. The infection and drugs are the main causes of renal AKI. The operation especially operation of heart and vessel is the main cause of HA-AKI. The multiple organ dysfunctional syndrome is associated with significantly increased mortality. The hospital-acquired is the influence factor of cure rate.