摘要
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.
出处
《徐州医学院学报》
CAS
2013年第11期737-740,共4页
Acta Academiae Medicinae Xuzhou
基金
徐州市卫生局科技项目(xzw2011025)
关键词
急性肾损伤
医院获得性
预后
acute kidney injury, hospital- acquired
risk factors