重症医学科患者急性肾损伤的发病率及危险因素的分析

目的:探讨重症监护病房(intensive care unit,ICU)收治患者急性肾损伤(acute kidney injury,AKI)的发病率以及相关危险因素。方法:回顾分析ICU 1443例患者的临床资料,按照AKI临床诊断标准筛选AKI患者,进行病因分析,检测AKI患者的实验室指标,记录尿量、住ICU时间等用Logistic回归分析影响预后的危险因素。结果:1443例ICU患者中符合2012年KDIGO-AKI诊断标准的患者98例(6.7%),其中病死32例(32.65%),需肾替代治疗50例(51.02%),随着AKI患者年龄和分期的增大,病死率越高;病因构成中脓毒症性AKI患者48例(48.98%),非脓毒症性AKI患者50例(51.02%),脓毒症性AKI患者住ICU时间和住院时间均较非脓毒症性AKI患者长(t=2.292,P=0.024;t=2.083,P=0.040),且行肾替代治疗比率较高(χ2=4.083,P=0.043)。Logistic回归分析显示老年、少尿、休克、酸中毒、AKI 3期、升压药物、感染和需肾替代治疗是AKI预后不良的危险因素。结论:ICU中AKI患者的发病率和病死率均较高,AKI的预后与多种因素有关,及早发现并干预治疗对降低AKI病死率具有重要意义。

Incidence and Risk Factors of Acute Kidney Injury in Intensive Care Unit Patients

Objective：To investigate the incidence and risk factors of AKI in intensive care unit patients. Methods： Datum of 1443 patients admitted to Intensive Care Unit（ICU） from February 2010 to December 2012 were collected and analyzed retro spectively. AKI patients were screened according to the clinical diagnostic criteria of AKI. The etiological diseases, laboratory indicators, urine output, length of ICU stay were analyzed, and logistic regression analysis was performed to investigate the risk factors for the prognosis of AKI. Results： AKI occurred in 98 of all patients （6.7%） under KDIGO-AKI criteria. Among the AKI patients, 32 cases（32.65%） died, and 50 cases （51.02%） need renal replacement therapy. The mortality rate in- creased with AKI stage and age. According to the individual etiological disease, 48 cases （48. 98%） were septic AKI and 50 ca- ses （51.02%） were non-septic AKI. Septic AKI patients had longer ICU stay and hospital stay than non-septic AKI patients（t = 2. 292, P = 0. 024 ; t = 2. 083, P = 0. 040, respectively） as well as higher rates of renal replacement therapy （χ^2 = 4. 083, P = 0. 043）. On logistic regression, elderly, oliguria, shock, metabolic acidosis, stage 3 of AKI, vasopressors, infection and need of renal replacement therapy were independent predictors of mortality in AKI. Conclusions： AKI patients have high incidence and mortality in ICU. A variety of factors are related to the prognosis of AKI. Early detection and effective therapeutic meas- ures are important to reduce the mortality of AKI patients in ICU.