重度子痫前期并发急性肾损伤临床分析

Analysis of the clinical characteristics for severe preeclampsia complicated with acute kidney injury

目的了解重度子痫前期并发急性肾损伤(acute kidney injury,AKI)患者的临床发病特点。方法对广州医科大学附属第三医院产科2005年8月至2011年7月收治的90例重度子痫前期并发AKI的病例资料进行回顾性分析,包括患者的一般资料、发病特点和临床结局等。结果 (1)重度子痫前期并发AKI的主要病因依次为严重产后出血、胎盘早剥、HELLP综合征以及合并基础肾脏疾病;(2)多器官功能障碍的发生率为63.3%(57/90),重症监护病房入住率64.4%(58/90),病死率15.6%(14/90);(3)AKI 1期治愈率71.9%(23/32),2期治愈率62.5%(5/8),3期治愈率28.0%(14/50),即随着急性肾损伤分期的增加,重度子痫前期并发AKI患者的治愈率逐渐下降,而病死率有所增加;(4)重度子痫前期合并AKI死亡的14例患者中,主要死因分别为多器官功能障碍7例,脑血管意外4例,严重产后出血2例,呼吸衰竭1例。结论重度子痫前期并发AKI的主要病因为严重产后出血、胎盘早剥、HELLP综合征以及合并基础肾脏疾病;并发多器官功能障碍、脑血管意外和严重产后出血是患者死亡的主要原因。

Objective To investigate the clinical characteristics of severe preeclampsia complicated with AKI. Methods A retrospective study was conducted in 90 cases of severe preeclampsia complicated with AKI, who were admitted to the Third Affiliated Hospital of Guangzhou Medical University from August 2005 to July 2011. We studied the general condition, clinical characteristics and clinical outcomes of the patients. Results （ 1 ） The leading causes of severe preeclampsia complicated with acute kidney injury were severe postpartum hemorrhage, placental abruption, HELLP syndrome and kidney disease. （2） Patients with critical condition, the incidence of multiple organ dysfunction was 63.3% （57/90）, and 58 （64.4%） cases admitted to the ICU. The total mortality was 15.6% （14/90）. （3） With the increase of AKI stage, the curative rate was 71.9% （23/32）in stage I; 62. 5% （5/8）in stage 11 and 28.0% （14/50）in stage m; and AKIN criteria seem to have association with mortality. （4） The main causes of death for severe preeclampsia complicated with AKI included multiple organ dysfunction, cerebrovascular accident, severe postpartum hemorrhage and respiratory failure. Conclusions The main etiologies of severe preeclampsia complicated with acute kidney injury were severe postpartum hemorrhage, placental abruption, HELLP syndrome and kidney disease. The main causes of death for severe preeclampsia complicated with AKI included multiple organ dysfunction, cerebrovascular accident, severe postpartum hemorrhage and respiratory failure.