中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
4期
260-264
,共5页
岳金凤%吴大玮%李琛%翟茜%陈晓梅%丁士芳%杜滨峰%李远
嶽金鳳%吳大瑋%李琛%翟茜%陳曉梅%丁士芳%杜濱峰%李遠
악금봉%오대위%리침%적천%진효매%정사방%두빈봉%리원
重症监护病房%急性肾损伤%诊断标准%危险因素%预后
重癥鑑護病房%急性腎損傷%診斷標準%危險因素%預後
중증감호병방%급성신손상%진단표준%위험인소%예후
Intensive care units%Acute Renal Injury%Diagnostic Criteria%Risk Factor%Prognosis
目的 以急性肾损伤网络(AKIN)诊断标准分析入住综合重症监护病房(ICU)危重症患者急性肾损伤(AKI)的发病率和预后,并探讨影响患者ICU病死率的相关因素.方法 回顾性分析2008年1月至2009年12月入住山东大学齐鲁医院综合ICU≥24 h的544例患者临床资料,应用AKIN分级标准将患者分为4组(肾功能正常组、AKI Ⅰ期组、AKIⅡ期组和AKI Ⅲ期组).结果 (1)544例患者中,符合AKI诊断标准191例(35.3%),其中AKI Ⅰ期组81例(14.8%),AKIⅡ期组45例(8.2%)、AKI Ⅲ期组65例(11.9%).(2)AKI(Ⅰ+Ⅱ+Ⅲ期)组患者病死率明显高于肾功能正常组患者(48%比11%,OR=7.48,95%CI4.831～11.587,P＜0.001).住ICU病死率随AKI分期加重而增加:AKIⅠ期组37%,AKI Ⅱ期组51%,AKI Ⅲ期组60%.(3)AKI各期均为影响ICU患者死亡的独立危险因素,其他的危险因素包括:原发病为内科疾病、感染性休克、多器官功能衰竭、存在慢性基础疾病、APACHEⅡ评分、需要使用机械通气及肾脏替代治疗.结论 AKI的发生和分期与患者临床预后密切相关,即使是轻度AKI患者病死率也明显高于肾功能正常组.AKIN标准对ICU患者发生AKI的早期诊断和判断预后有重要的指导意义.
目的 以急性腎損傷網絡(AKIN)診斷標準分析入住綜閤重癥鑑護病房(ICU)危重癥患者急性腎損傷(AKI)的髮病率和預後,併探討影響患者ICU病死率的相關因素.方法 迴顧性分析2008年1月至2009年12月入住山東大學齊魯醫院綜閤ICU≥24 h的544例患者臨床資料,應用AKIN分級標準將患者分為4組(腎功能正常組、AKI Ⅰ期組、AKIⅡ期組和AKI Ⅲ期組).結果 (1)544例患者中,符閤AKI診斷標準191例(35.3%),其中AKI Ⅰ期組81例(14.8%),AKIⅡ期組45例(8.2%)、AKI Ⅲ期組65例(11.9%).(2)AKI(Ⅰ+Ⅱ+Ⅲ期)組患者病死率明顯高于腎功能正常組患者(48%比11%,OR=7.48,95%CI4.831～11.587,P＜0.001).住ICU病死率隨AKI分期加重而增加:AKIⅠ期組37%,AKI Ⅱ期組51%,AKI Ⅲ期組60%.(3)AKI各期均為影響ICU患者死亡的獨立危險因素,其他的危險因素包括:原髮病為內科疾病、感染性休剋、多器官功能衰竭、存在慢性基礎疾病、APACHEⅡ評分、需要使用機械通氣及腎髒替代治療.結論 AKI的髮生和分期與患者臨床預後密切相關,即使是輕度AKI患者病死率也明顯高于腎功能正常組.AKIN標準對ICU患者髮生AKI的早期診斷和判斷預後有重要的指導意義.
목적 이급성신손상망락(AKIN)진단표준분석입주종합중증감호병방(ICU)위중증환자급성신손상(AKI)적발병솔화예후,병탐토영향환자ICU병사솔적상관인소.방법 회고성분석2008년1월지2009년12월입주산동대학제로의원종합ICU≥24 h적544례환자림상자료,응용AKIN분급표준장환자분위4조(신공능정상조、AKI Ⅰ기조、AKIⅡ기조화AKI Ⅲ기조).결과 (1)544례환자중,부합AKI진단표준191례(35.3%),기중AKI Ⅰ기조81례(14.8%),AKIⅡ기조45례(8.2%)、AKI Ⅲ기조65례(11.9%).(2)AKI(Ⅰ+Ⅱ+Ⅲ기)조환자병사솔명현고우신공능정상조환자(48%비11%,OR=7.48,95%CI4.831～11.587,P＜0.001).주ICU병사솔수AKI분기가중이증가:AKIⅠ기조37%,AKI Ⅱ기조51%,AKI Ⅲ기조60%.(3)AKI각기균위영향ICU환자사망적독립위험인소,기타적위험인소포괄:원발병위내과질병、감염성휴극、다기관공능쇠갈、존재만성기출질병、APACHEⅡ평분、수요사용궤계통기급신장체대치료.결론 AKI적발생화분기여환자림상예후밀절상관,즉사시경도AKI환자병사솔야명현고우신공능정상조.AKIN표준대ICU환자발생AKI적조기진단화판단예후유중요적지도의의.
Objective To evaluate the value of the AKIN criteria of acute kidney injury (AKI) in the incidence and prognoses in critically ill patients, and to further identify risk factors associated with the prognoses of the critically ill patients. Methods We retrospectively studied 544 adult patients hospitalized for ≥ 24 h to a comprehensive ICU with 16 beds in teaching hospital from January 2008 to December 2009. Based on AKIN criteria, these patients were classified into four groups: NAKI (no AKI), AKI Ⅰ ,AKI Ⅱ , and AKI Ⅲ respectively. Results ( 1 ) Of the patients, 191 (35.5%) fulfilled the criteria for AKI ( 14. 8% had AKI Ⅰ 8. 2% had AKI Ⅱ and 11.9% had AKI Ⅲ ). (2)Mortality in the ICU was much higher in patients with AKI than in patients with no AKI (48% vs 11%, OR 7.48,95 % CI 4. 831 - 11. 587,P＜0. 001 ). The mortality rate was 37% for AKI Ⅰ group, 51% for AKI Ⅱ group and 60% for AKI Ⅲ group. (3)In multivariate analysis, each AKIN category was independently associated with ICU mortality.The other independent risk factors for ICU mortality included internal medical diseases, septic shock, preexisting chronic illness, APACHE Ⅱ score, the number of failed organs, mechanical ventilation and CRRT.Conclusions The AKIN category closely relates to the prognoses in critically ill patients, even the mild degree of AKI with a much higher mortality rate than the patients without AKI. The AKIN criteria has some direction significance to the early detection and classification of AKI and to the prediction of clinical outcomes in critically ill patients.
