住院患者社区获得性与医院获得性急性肾损伤回顾性研究

发布时间：2018-06-03 08:00

本文选题：急性肾功能不全 + 预后　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:回顾性分析新疆地区社区获得性急性肾损伤(CA-AKI)与医院获得性急性肾损伤(HA-AKI)患者的人口学特征、疾病危险因素及死亡相关危险因素等。方法:应用医院病例系统筛选新疆医科大学第一附属医院2014年1月、7月19 528例成人住院患者临床资料。根据改善全球肾脏病预后组织(KDIGO)指南确认544例AKI患者组成研究队列,按照发病时间与入院时间的关系,将上述患者分成CA-AKI组与HA-AKI组。回顾性分析CA-AKI组(330例)与HA-AKI组(214例)患者的临床资料及全因死亡率。结果:住院患者AKI发生率为2.8%(544/19 528),其中CA-AKI组为1.7%(330/19 528),HA-AKI组为1.1%(214/19 528)。CA-AKI组患者平均年龄大于HA-AKI组[(62.9±16.8)岁比(56.6±15.9)岁,P0.01]。CA-AKI组中62.4%为内科患者,HA-AKI组中64.1%为外科患者。两组合并的基础疾病主要包括心血管系统疾病、高血压、糖尿病和慢性肝病。肾前性因素在两组均占明显优势。CA-AKI组住院时间明显少于HA-AKI组[12(8,20)d比19(12,27)d,P0.01],全因死亡率亦明显低于HA-AKI组(11.5%比20.1%,P=0.005)。多因素Logistic逐步回归结果提示,ICU住院情况和休克是CA-AKI组和HA-AKI组患者死亡的独立危险因素;糖尿病(OR=3.019)是CA-AKI组患者死亡的独立危险因素;高龄(OR=3.303)、少尿(OR=6.906)、使用解热镇痛药(OR=13.079)及存在多器官功能不全综合征(OR=17.778)是HA-AKI组患者死亡的独立危险因素。结论:住院患者中AKI的发生并不少见,肾前性病因均为CA-AKI与HA-AKI主要病因。HA-AKI组全因死亡率明显高于CA-AKI组,两组预后的独立危险因素不尽相同。
[Abstract]:Objective: to retrospectively analyze the demographic characteristics, disease risk factors and death risk factors of patients with acute renal injury (CA-AKI) and hospital acquired acute renal injury (HA-AKI) in Xinjiang. Methods: the clinical data of 19 528 adult inpatients in the first affiliated Hospital of Xinjiang Medical University in January and July 2014 were screened by the hospital case system. According to the KDIGO guidelines for improving the prognosis of Nephropathy, 544 patients with AKI were cohort. According to the relationship between onset time and admission time, the patients were divided into CA-AKI group and HA-AKI group. The clinical data and total cause mortality of CA-AKI group (330 cases) and HA-AKI group (214 cases) were analyzed retrospectively. Results: the incidence of AKI in hospitalized patients was 2.84% 19 528%. The average age of HA-AKI patients in CA-AKI group was 1.30 / 19 528% higher than that in HA-AKI group [62.9 卤16.8 years old vs 56.6 卤15.9yr P0.01]. 62.4% of the patients in CA-AKI group were surgical patients in HA-AKI group, 64.1% in HA-AKI group were surgical patients, the average age of HA-AKI group was higher than that of HA-AKI group [62.9 卤16.8 years old vs 56.6 卤15.9years old P0.01]. The average age of HA-AKI group in CA-AKI group was 64.1% in HA-AKI group. The underlying diseases in both groups included cardiovascular diseases, hypertension, diabetes, and chronic liver disease. The prerenal factors were significantly superior in both groups. The hospitalization time of CA-AKI group was significantly less than that of HA-AKI group [128U / 20d vs 1912121227dU P0.01], and the total mortality rate was significantly lower than that of HA-AKI group (11.5% vs 20.1g / kg). The results of stepwise regression of multivariate Logistic suggested that hospitalization and shock were independent risk factors for death in CA-AKI group and HA-AKI group, and diabetes mellitus 3.019) was an independent risk factor for death in CA-AKI group. The risk factors of death in the HA-AKI group were 3.303g, 6.906g, 13.079) and 17.778), which were used as antipyretic analgesics, and with multiple organ dysfunction syndrome (MOS), which were the independent risk factors of death in HA-AKI group. Conclusion: the incidence of AKI is not uncommon in inpatients. The main causes of prerenal venereal diseases are CA-AKI and HA-AKI. The all-cause mortality in HA-AKI group is significantly higher than that in CA-AKI group, and the independent risk factors for prognosis are different between the two groups.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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