住院患者急性肾损伤发生的流行病调查:一项单中心回顾性观察性研究

发布时间：2018-05-15 22:21

本文选题：急性肾损伤 + 住院患者　；参考：《南京医科大学学报(自然科学版)》2017年03期

【摘要】：目的:研究住院患者急性肾损伤(acute kidney injury,AKI)的发病、病因及诊断情况。方法:筛选南京医科大学第一附属医院2013年10月—2014年9月收治的18岁以上符合AKI定义的患者,进行横断面研究。分析住院患者的AKI发病、病因、诊断情况和分布科室等。结果:(1)AKI发病率为1.61%(1 401/87 196),男女比例为2.03∶1、平均年龄(63.2±37.2)岁、城市人口占58.3%、中位住院时间18(11~28)d、中位住院花费5.72(2.50~12.16)万元。住院期间肾脏功能完全恢复/部分恢复的占66.5%,30 d病死率为35.3%;(2)AKI实际检出率0.76%,及时诊断率44.0%、延迟诊断率3.3%、漏诊率52.7%;肾科患者AKI的诊断率(89.3%)最高,外科患者诊断率最低,漏诊率高达75.1%;(3)AKI的发病情况因科室而异:肾科3.5%,其他内科1.3%,外科1.0%,重症监护病房(intensive care unit,ICU)18.0%;诊断AKI的患者中肾科、其他内科、外科、ICU分别占7.4%、37.1%、30.1%、25.4%;心内科、血液科、胸心外科、ICU是AKI发生的相对高危科室;(4)按AKI病因,肾前性、肾性、肾后性分别占42.1%、52.2%、5.7%;其中肾前性组年轻患者比例高,基础肾功能好,但漏诊率最高(85.7%);(5)本研究AKI 1期、2期、3期患者分别占38.0%、22.1%、40.0%,随AKI分期越高,及时诊断率越高,漏诊率越低,但ICU住院时间越长,肾功能恢复越差,30 d病死率越高。结论:AKI在住院患者中较常见,检出率低,漏诊率高。各科医师要加强AKI诊断标准的学习和高危因素的识别,建立AKI预警系统,及早发现和诊断,以改善AKI预后。
[Abstract]:Objective: to study the pathogenesis, etiology and diagnosis of acute kidney injury-AKI in inpatients with acute renal injury. Methods: the patients over 18 years old who met the definition of AKI in the first affiliated Hospital of Nanjing Medical University from October 2013 to September 2014 were selected for cross-sectional study. To analyze the incidence, etiology, diagnosis and distribution of AKI in inpatients. Results the incidence of AKI was 1.61 / 1401 / 87 1960.The ratio of male to female was 2.03: 1, with an average age of 63.2 卤37.2 years. The urban population accounted for 58.3%. The median hospital stay was 18111128d, and the median hospitalization cost was 5.72m2.50,120,600 yuan. During the period of hospitalization, the mortality rate of complete recovery / partial recovery of renal function in 66.5 / 30 days was 35.30.The actual detection rate of AKI was 0.76, the prompt diagnosis rate was 44.0, the delayed diagnosis rate was 3.33,52.7 percent; the diagnosis rate of AKI in renal patients was the highest, and the diagnosis rate of surgical patients was the lowest. The rate of missed diagnosis was as high as 75.1%. The incidence of AKI varied from department to department: kidney 3.5m, other internal medicine 1.3s, surgery 1.0g, intensive care unit ICU18.0; Nephrology, other internal medicine and surgical ICU accounted for 7.437.1g / 30.1a 25.4; cardiology, hematology, ICU 18.0; cardiology, hematology, According to the etiology of AKI, prerenal and posterior renal diseases were 42.1% and 52.2%, respectively, in which the proportion of young patients in prerenal group was high, and the basic renal function was good, according to the etiology of AKI. However, the highest rate of missed diagnosis was 85.7%. In this study, 38.0% of the patients in stage 1 and 22.2% and 40.0% in stage 3 of AKI, the higher the stage of AKI, the higher the rate of timely diagnosis, the lower the rate of missed diagnosis, but the longer the hospitalization time of ICU, the higher the mortality of 30 days after the recovery of renal function. ConclusionTwo-one AKI is more common in inpatients with low detection rate and high missed diagnosis rate. Doctors should strengthen the study of AKI diagnostic criteria and identify high risk factors, establish AKI early warning system, early detection and diagnosis, in order to improve the prognosis of AKI.
【作者单位】：南京医科大学第一附属医院肾科;
【基金】：江苏省青年自然基金(BK20151022) 江苏省教育厅六大人才高峰项目(WSN-056) 江苏省临床医学科技专项项目(BL2014080)
【分类号】：R692

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