中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2012年
7期
742-745
,共4页
胡家昌%田锐%唐雪%王瑞兰%俞康龙
鬍傢昌%田銳%唐雪%王瑞蘭%俞康龍
호가창%전예%당설%왕서란%유강룡
多器官功能障碍综合征%急性肾损伤%肾脏替代治疗%危险因素%预后
多器官功能障礙綜閤徵%急性腎損傷%腎髒替代治療%危險因素%預後
다기관공능장애종합정%급성신손상%신장체대치료%위험인소%예후
Multiple organ dysfunction syndrome%Acute kidney injury%Renal replacement therapy%Risk factors%Prognosis
目的 探讨ICU病房医院获得性急性肾损伤(AKI)相关的危险因素、临床特点及预后.方法 回顾分析我院ICU病房48例行肾脏替代治疗(RRT)的合并多器官功能障碍综合征(MODS)的AKI患者,以AKI发生时间分为医院获得性AKI组(HA-AKI)(13例,入院时肾功能正常,入院48 h后发生AKI)和社区获得性AKI组(CA-AKI)(35侧,入院时即存在或48 h内发生AKI).观察比较两组在一般情况、脏器衰竭、机械通气、肾脏替代治疗(RRT)及预后的不同.结果 HA-AKI组平均年龄大于CA-AKI组(P =0.022),CA-AKI组前三位原发病分别为严重感染(42.8％)、慢性肾脏疾病(CKD)并发AKI(11.4％)及多发伤(不伴头外伤)(8.6％),HA-AKI组严重感染仍占首位(30.8％),其次为脑卒中(23.1％,P=0.024)、多发伤伴头外伤(15.4％,P=0.018)及消化道出血(15.4％)；HA-AKI组发生4个以上脏器功能衰竭占84.6％,明显高于CA-AKI组65.7％ (P =0.000)；HA-AKI组第1天血钠(P=0.036)及HCO3水平(P=0.001)明显高于CA-AKI组,且尿量偏多(P =0.046)；HA-AKI组尿素氮(BUN)进行性增高,到第7天BUN水平明显高于第1天(P =0.015),而CA-AKI组患者入院后7d内Cr及BUN变化不明显,但第7天血钠有所升高(P =0.023)、HC03改善(P=0.030)；虽然HA-AKI组入院24 h APACHEⅢ评分明显低于CA-AKI组[(53.2±22.8)分与(89.1±25.7)分,P=0.000),住院时间、ICU住院时间及机械通气时间较CA-AKI组明显延长(P＜0.05),但两组患者行RRT治疗次数、转归及肾功能恢复情况比较差异均无统计学意义(P均＞0.05).结论 入院24 h APACHEⅢ评分不能准确反映合并HA-AKI的MODS患者的预后,HA-AKI在年龄、原发病、脏器功能改变等方面与CA-AKI明显不同.
目的 探討ICU病房醫院穫得性急性腎損傷(AKI)相關的危險因素、臨床特點及預後.方法 迴顧分析我院ICU病房48例行腎髒替代治療(RRT)的閤併多器官功能障礙綜閤徵(MODS)的AKI患者,以AKI髮生時間分為醫院穫得性AKI組(HA-AKI)(13例,入院時腎功能正常,入院48 h後髮生AKI)和社區穫得性AKI組(CA-AKI)(35側,入院時即存在或48 h內髮生AKI).觀察比較兩組在一般情況、髒器衰竭、機械通氣、腎髒替代治療(RRT)及預後的不同.結果 HA-AKI組平均年齡大于CA-AKI組(P =0.022),CA-AKI組前三位原髮病分彆為嚴重感染(42.8％)、慢性腎髒疾病(CKD)併髮AKI(11.4％)及多髮傷(不伴頭外傷)(8.6％),HA-AKI組嚴重感染仍佔首位(30.8％),其次為腦卒中(23.1％,P=0.024)、多髮傷伴頭外傷(15.4％,P=0.018)及消化道齣血(15.4％)；HA-AKI組髮生4箇以上髒器功能衰竭佔84.6％,明顯高于CA-AKI組65.7％ (P =0.000)；HA-AKI組第1天血鈉(P=0.036)及HCO3水平(P=0.001)明顯高于CA-AKI組,且尿量偏多(P =0.046)；HA-AKI組尿素氮(BUN)進行性增高,到第7天BUN水平明顯高于第1天(P =0.015),而CA-AKI組患者入院後7d內Cr及BUN變化不明顯,但第7天血鈉有所升高(P =0.023)、HC03改善(P=0.030)；雖然HA-AKI組入院24 h APACHEⅢ評分明顯低于CA-AKI組[(53.2±22.8)分與(89.1±25.7)分,P=0.000),住院時間、ICU住院時間及機械通氣時間較CA-AKI組明顯延長(P＜0.05),但兩組患者行RRT治療次數、轉歸及腎功能恢複情況比較差異均無統計學意義(P均＞0.05).結論 入院24 h APACHEⅢ評分不能準確反映閤併HA-AKI的MODS患者的預後,HA-AKI在年齡、原髮病、髒器功能改變等方麵與CA-AKI明顯不同.
목적 탐토ICU병방의원획득성급성신손상(AKI)상관적위험인소、림상특점급예후.방법 회고분석아원ICU병방48례행신장체대치료(RRT)적합병다기관공능장애종합정(MODS)적AKI환자,이AKI발생시간분위의원획득성AKI조(HA-AKI)(13례,입원시신공능정상,입원48 h후발생AKI)화사구획득성AKI조(CA-AKI)(35측,입원시즉존재혹48 h내발생AKI).관찰비교량조재일반정황、장기쇠갈、궤계통기、신장체대치료(RRT)급예후적불동.결과 HA-AKI조평균년령대우CA-AKI조(P =0.022),CA-AKI조전삼위원발병분별위엄중감염(42.8％)、만성신장질병(CKD)병발AKI(11.4％)급다발상(불반두외상)(8.6％),HA-AKI조엄중감염잉점수위(30.8％),기차위뇌졸중(23.1％,P=0.024)、다발상반두외상(15.4％,P=0.018)급소화도출혈(15.4％)；HA-AKI조발생4개이상장기공능쇠갈점84.6％,명현고우CA-AKI조65.7％ (P =0.000)；HA-AKI조제1천혈납(P=0.036)급HCO3수평(P=0.001)명현고우CA-AKI조,차뇨량편다(P =0.046)；HA-AKI조뇨소담(BUN)진행성증고,도제7천BUN수평명현고우제1천(P =0.015),이CA-AKI조환자입원후7d내Cr급BUN변화불명현,단제7천혈납유소승고(P =0.023)、HC03개선(P=0.030)；수연HA-AKI조입원24 h APACHEⅢ평분명현저우CA-AKI조[(53.2±22.8)분여(89.1±25.7)분,P=0.000),주원시간、ICU주원시간급궤계통기시간교CA-AKI조명현연장(P＜0.05),단량조환자행RRT치료차수、전귀급신공능회복정황비교차이균무통계학의의(P균＞0.05).결론 입원24 h APACHEⅢ평분불능준학반영합병HA-AKI적MODS환자적예후,HA-AKI재년령、원발병、장기공능개변등방면여CA-AKI명현불동.
Objective To investigate the related risk factors,clinical features and prognosis of hospital-acquired acute kidney injury (AKI) in intensive care unit (ICU).Methods We retrospectively analyzed 48 patients with both acute kidney injury and multiple organ dysfunction syndrome (MODS),who received renal replacement therapy from October 2006 to February 2011 in our ICU.According to whether the occurrence time of AKI was 48 hours after admission,they were divided into hospital-acquired AKI (HA-AKI) group and community-acquired AKI (CA-AKI) group,with 13 and 35 cases respectively.We compared the differences between these two groups in gender,age,acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ),primary diseases,days of mechanical ventilation,times of renal replacement therapy,number and indicators of organ failure,prognosis,renal function recovery,length of stay in ICU and hospital.Results The mean age of HA-AKI group is ( 64.5 ± 21.4) years,which is older than that in CA-AKI group ( 50.2 ± 17.5 ) years (P=0.022).The top three primary diseases in CA-AKI group are severe infection(42.8％ ),chronic kidney disease (CKD) concurrency of AKI ( 11.4％ ) and multiple trauma without head injury ( 8.6％ ).However severe infection still occupies the first in HA-AKI group ( 30.8％ ),followed by stroke (23.1％,P=0.024),multiple trauma with head injury( 15.4％,P=0.018 ) and gastrointestinal bleeding( 15.4％ ) ;Patients in HA-AKI group with more than four organ failures account for 84.6％,significantly higher than 65.7％ in CA-AKI group (P=0.000).On the first day,the levels of serum sodium ( P =0.036 ) and bicarbonate ( P=0.001 ) in HA-AKI group are higher than that in CA-AKI group,and the urinary volume is more(P =0.046).In HA-AKI group,the level of urea nitrogen on the seven day increases so progressively that it becomes significantly higher than that on the first day(P=0.015),but in CA-AKI group,there is no significant change in the levels of serum creatinine and urea nitrogen after AKI,while the levels of seruum sodium ( P=0.023 ) and bicarbonate ( P=0.030) increase significantly;APACHE Ⅲ score in HA-AKI group after admission 24 hours is significandy lower than that in CA-AKI group(53.2 ±22.8) point vs (89.1±25.7) point,P=0.000),and the length of stay in ICU and hospital and days of mechanical ventilation in HA-AKI group are significantly longer than that in CA-AKI group,but there are no significant differences in times of RRT therapy,prognosis and recovery of renal function.Conclusion APACHE Ⅲ score after 24 hours of admission does not accurately reflect the prognosis of patients with MODS and HA-AKI.There are great differences in age,primary diseases,organ function changes and other aspects of HA-AKI when compared with CA-AKI.
