电子预警系统在急性肾损伤高危病房的初步应用

Preliminary Application of Electronic Alert System in High-risk Wards of Acute Kidney Injury

目的:探讨电子预警系统在急性肾损伤(AKI)高危病房初步应用的价值。方法:前瞻性、随机对照设计。在重症监护室和心血管病区运行AKI电子预警软件。人工判断的AKI为"金标准"。系统根据血清肌酐自动识别AKI后,随机分为预警组(318例)与非预警组(623例),对预警组发出提醒弹窗。结果:电子预警系统判断AKI的灵敏度、特异度、Youden指数和正确率分别为100%、97.7%、97.7%和98.1%。预警组的AKI诊断率(5.6%和1.9%,P=0.002)和扩展AKI(AKI及多器官功能衰竭)诊断率(11.2%和4.3%,P<0.001)都高于非预警组。在心外科病房,AKI诊断率(3.9%和1.2%,P=0.098)及扩展AKI诊断率(9.0%和2.9%,P=0.003)高于非预警组。在肾内科会诊率、院内肾替代治疗、院内死亡、肾功能恢复等观察终点中,两组患者差异无统计学意义。结论:电子预警系统有助于辅助AKI诊断。由于临床对预警信息的重视不够,该系统还未能改善临床不良事件。

Objective： To investigate the preliminary application value of electronic alert system for acute kidney injury（AKI） among high-risk wards. Methods： A prospective, randomized, controlled study was conducted. We ran the system in intensive care units and cardiovascular departments. Artificial diagnosis of AKI was considered as ＂gold standard＂. The system automatically diagnosed AKI based on serum creatinine. Patients were randomly assigned to alert group（318 patients） and non-alert group（623 patients）. Results： The sensitivity, specificity, Youden index and accuracy of AKI alert system were 100%, 97.7%, 97.7% and 98.1% respectively. The diagnosis rates of AKI（5.6% and 1.9%, P =0.002） and expanded AKI（AKI and multiple organ failure, 11.2%和4.3%, P〈0.001） in alert group were higher than non-alert group. In the cardiovascular surgery wards,the diagnosis rates of AKI（3.9% and 1.2%, P =0.098） and expanded AKI（9.0% and 2.9%, P =0.003） in alert group were higher than non-alert group. There was not significantly difference in nephrology consultation, dialysis, rehabilitation of renal function or death in the two groups. Conclusion： This electronic alert contributed to the diagnosis of AKI. Because clinicians had not given enough attention to the alert message, the system had not prevented clinical adverse events.