肾病专科医院住院患者发生急性肾损伤356例临床分析

Clinical analysis of 356 cases with acute kidney injury in hospitalized patients of a kidney disease specialized hospital

目的:分析民营肾病专科医院住院患者发生急性肾损伤(AKI)的比例、病因及其预后。方法 :收集本院2011年6月30日至2014年6月30日住院患者资料,共11 540例,根据改善全球肾脏病预后组织有关AKI诊断标准,对发生AKI住院患者的临床资料进行分析。按年龄分为老年组和非老年组,统计AKI的发生率、病因、诱因及其转归。结果:3年内住院患者发生AKI共356例(3.1%)。引起AKI的病因中肾前性占42.1%,肾实质性占48.3%,肾后性占9.6%。主要病因为肾毒性药物(26.7%)和低血容量(20.2%)。治疗后77.3%患者的肾功能得到完全或部分恢复,恶化率为22.7%。老年组与非老年组的肾前性、肾后性因素差异均无统计学意义(P>0.05),2组肾实质性因素差异有统计学意义(P<0.05)。结论:民营肾病专科医院住院患者AKI恶化率高,AKI主要病因是肾毒性药物及低血容量。及早诊断对早期预防和积极干预AKI,提高AKI的生存率及改善预后具有重要意义。

Objective To investigate the ratio, pathogenesis, and prognosis of acute kidney injury（AKI） patients in a kidney disease specialized hospital. Methods A total of 11 540 patients were admitted from June 30, 2011 to June 30,2014. AKI was diagnosed according to the AKI diagnosis criteria issued by global kidney disease prognosis organization,the clinical data of AKI patients were analyzed respectively, and the AKI incidence rate, cause, incentive, transition and outcome were assessed. Results There were 356 AKI cases, accounts for 3.1%（356/11 540） of all the inpatients. The pathogenies of AKI were as follows, prerenal in 42.1%, renal parenchyma in 48.3%, postrenal in 9.6%. The pathogenesis were nephrotoxic drugs（26.7%） and hypovolemia（20.2%）. After treatment, 77.3% patients had their renal function recovered totally or partially, and the worsening rate was 22.7%. For elderly group and non-elderly group, no statistical significant difference（P〉0.05） was found inprerenal and postrenal cases, but significant difference was seen for renal parenchyma AKI（P〈0.05）. Conclusions The morbidity and worsening rate of AKI in specialized kidney disease hospital are roughly the same as in general hospital. The main pathogenesis include nephrotoxic drugs and hypovolemia. Early diagnosis of AKI plays a significant role in preventing AKI, enhancing the survival rate and improving prognosis of AKI.