产后急性肾损伤的临床特征及母婴预后

The clinical characteristics and prognosis in patients with postpartum acute kidney injury

目的探讨产后急性肾损伤(PPAKI)的临床特征及母婴预后。方法回顾性分析兰州大学第二医院2013年1月至2017年12月住院的产妇资料,记录符合PPAKI定义患者的临床表现、实验室检查、治疗及预后,统计分析PPAKI的发病情况病因及母婴结局。结果共有8437例产妇纳入研究,33例患者符合PPAKI诊断,发病率0.39%(33/8437)。69.7%(23/33)的患者需要ICU救治。AKI主要病因包括:HELLP综合征75.8%(25/33),子痫前期72.7%(24/33),产后大出血60.6%(20/33)。54.5%(18/33)的患者行肾脏替代治疗(RRT),RRT和非RRT的肾脏恢复时间比较,差异无统计学意义(P=0.062)。78.8%(26/33)的患者肾功能完全恢复,3.0%(1/33)的患者肾功能部分恢复,6.1%(2/33)的患者出院未再复查,失访率9.1%(3/33),仅3.0%(1/33)的患者透析依赖,无产妇死亡。胎儿早产发生率70.3%(26/37),低体重儿67.6%(25/37),胎儿存活率75.7%(28/37),存活患儿均身体健康生长发育良好。结论.PPAKI主要病因为HELLP综合征和子痫前期,是否替代治疗对肾脏恢复时间无影响,经积极诊治,母亲和胎儿预后良好。

Objective To investigale the clinical characteristics and prognosis in patients with postpartum acute kidney injury(PPAKI).Methods A retrospective survey was conducted to investigate patients with PPAKI admitted to our hospital from January 2013 to December 2017.Data regarding their clinical manifestation and laboratory examinations,treatment and outcomes were collected.The incidence,etiology,prognoses of maternal and infant were analyzed respectively.Results A total of 8437 puerpera were cnrolled,33 cases were diagnosed with PPAKI.The incidence of PPAKI was 0.39%(33/8437),and 69.7%(23/33)required ICU treatment.The main causes of AKI included HELLP syndrome(hermolytic anemia and elevated liver cnzymes and low platelet)75.8%(25/33),pre-eclampsia 72.7%(24/33),and postpartum hemorrhage 60.6%(20/33).A total of 54.5%(18/33)of patients required RRT,and there was no signifcant difference in renal recovery time between the two therapy(RRT and non-RRT)(P=0.062).Of the 33 PPAKI patients,the rates of kidney recovery completely and partially were 78.8%(26/33)and 3.0%(1/33),2 cases(6.1%)were not re-examined after discharging,3 cascs(9.1%)were lost 10 fllow-up.Only one paticnt(3.0%)remained dialysis dependent,and no maternal death occurred.The rates of preterm birth,low birth weight,and infant survival were 70.3%(26/37),67.6%(25/37),and 75.7%(28/37),respectively.All surviving infants were healthy and well-developed.Conclusions'The main causes of PPAKI are HELLP syndrome and pre-eclampsia.There is no significant difference in the recovery time of kidney whether or not RRT is perforned.After active trealment,the prognoses of mother and infanl are good.