174例医院获得性急性肾损伤的临床特点及影响预后的危险因素分析

Clinical characteristics of hospital-acquired acute kidney injury and risk factors influencing prognosis：report of 174 cases

目的 观察成人住院患者发生医院获得性急性肾损伤（HA-AKI）的临床特点,探讨影响预后的危险因素,为预防HA-AKI提供依据.方法 回顾性分析徐州市中心医院2010年1月-2011年12月成人住院患者中174例确诊HA-AKI的临床资料,观察病因、临床特点及预后,并分析具体病因及构成比.根据预后分为治愈好转组和未愈死亡组,分析影响预后的危险因素.结果 在174例HA-AKI患者中,根据病因分为肾前性52例（29.9%）、肾实质性114例（65.5%）和肾后性8例（4.6%）.其中,低血容量21例（12.1%）、抗生素37例（21.3%）、化疗药物19例（10.9%）、造影剂26例（14.9%）是主要病因.单因素分析显示,年龄〉60岁、冠心病、糖尿病、低血压、昏迷、机械通气、外伤及多器官功能障碍综合征（MODS）与HA-AKI的转归相关,差异有统计学意义（P〈0.05）.多因素Logistic回归分析显示冠心病（OR=2.130）、糖尿病（OR=1.805）、低血压（OR=3.077）、机械通气（OR=2.914）和MODS（OR=3.538）是HA-AKI患者影响患者预后的独立危险因素.结论 HA-AKI的病因主要是肾前性和肾实质性.早期关注危险因素可能有助于预防HA-AKI的发生,改善患者预后.

Objective To investigate the incidence, risk factors and outcome of hospital - acquired acute kidney in- jury （ HA - AKI） for the evidence of treatment and prevention. Methods 174 patients with HA - AKI treated in Xuzhou Central Hospital between January 2010 and December 2011, was retrospectively analyzed. Acute Kidney Injury Net （A- KIN） criteria was applied to define and classify the AKI. The patients were divided into 3 groups ： pre - renal, renal and post - renal HA - AKI etiologically and the percentage was analyzed. The etiologies, clinical characteristics （ age, gender and background chronic diseases such as hypertension, coronary heart disease and diabetes, with or without infection, co- ma and mechanical ventilation）, as well as prognostic factors were compared among patients who were divided into cured/ improved group and uncured/death group. Results Of the 174 patients with HA - AKI, 52 cases （29.9%） were pre - renal, 114 cases （65.5%） were renal, 8 cases （4.6%） were post - renal, among which low renal perfusion （21 cases, 12.1% ）, antibiotic （37 cases, 21.3% ）, chemotherapeutics （ 19 cases, 10.9% ）, and contrast medium （26 cases, 14.9% ） were the major causes of HA - AKI. Univariate analysis showed that prognosis was correlated with age 〉 60 years old, coronary heart disease, diabetes, hypotension, unconsciousness, mechanical ventilation, injuries, and multi- ple organ dysfunction syndrome （MODS）. Multivariate logistic regression analysis showed that 5 variables were independ- ent risk factors for prognosis of HA - AKI： coronary heart disease （ OR = 2. 130, 95% CI 1. 270 - 5. 491 ）, diabetes （ OR = 1. 805, 95% CI 1. 038 - 4. 760）, hypotension （ OR = 3. 077, 95% CI 1. 047 - 8. 233 ）, mechanical ventilation （OR =2.914, 95% CI 1. 196 -5.752）, and MODS （0R=3.538, 95% CI 1.203 -13.914）. Conclusion Pre -re- nal and renal factors are the major causes of HA - AKI. Paying close attention to the potential risk factors of HA - AKI may be beneficial to the prognosis of palients.