单中心急性肾损伤的临床特点分析

发布时间：2019-02-16 19:13

【摘要】：目的:回顾性分析我院重症监护室(ICU)患者中急性肾损伤(AKI)的发生率、危险因素以及356例AKI漏诊患者的漏诊率、漏诊原因,回顾性分析ICU中AKI患者的临床特点及危险因素,提高临床医生对AKI的认识和诊断水平,从而减少漏诊率,降低AKI发生率,改善患者预后。方法:以2014年1月和2014年7月我院诊断为AKI的患者以及同时期全部ICU患者中筛选出的256例AKI患者为研究对象,分析ICU患者AKI的发生率、危险因素和漏诊患者的漏诊率、漏诊原因、医生知晓率以及引起AKI漏诊的危险因素。结果:(1)本中心AKI发生率为2.80%,男女比例2.1:1,平均年龄(60.35±16.75)岁,AKI漏诊率为65.4%,医生对AKI的知晓率为40.9%;ICU患者中AKI发生率为58.3%,男女比例2.3:1,平均年龄(61.44±16.67)岁。(2)单因素分析提示:脑血管病、其它心脏疾病、多器官功能衰竭、脓毒血症、恶性肿瘤晚期、β-内酰胺类药物史、解热镇痛药物史是AKI患者漏诊的危险因素;多器官功能衰竭、脓毒血症、恶性肿瘤晚期、急性呼吸窘迫综合征、气管插管呼吸机治疗、休克是ICU患者AKI发生的危险因素;(3)logistic逐步回归模型结果:脑血管病、恶性肿瘤晚期、多器官功能衰竭、脓毒血症、β-内酰胺类药物史、解热镇痛药物史是影响AKI患者漏诊的独立危险因素;多器官功能衰竭、脓毒血症、休克为影响ICU患者AKI发生的独立危险因素,恶性肿瘤晚期为保护性因素。结论:(1)脑血管病、多器官功能衰竭、脓毒血症、解热镇痛药物史是AKI患者漏诊的独立危险因素,β-内酰胺类药物史、恶性肿瘤晚期是AKI降低漏诊率的保护性因素;(2)多器官功能衰竭、脓毒血症、休克为ICU患者中AKI发生的独立危险因素,恶性肿瘤晚期是影响ICU患者AKI发生的保护性因素。
[Abstract]:Objective: to analyze retrospectively the incidence and risk factors of acute renal injury (AKI) in patients with (ICU) in intensive care unit (ICU) of our hospital, and the missed diagnosis rate and cause of missed diagnosis in 356 patients with AKI. The clinical characteristics and risk factors of patients with AKI in ICU were analyzed retrospectively to improve the understanding and diagnosis level of AKI in order to reduce the rate of missed diagnosis, reduce the incidence of AKI and improve the prognosis of the patients. Methods: the incidence of AKI, risk factors and missed diagnosis rate of ICU patients were analyzed by using 256 AKI patients who were diagnosed as AKI in our hospital in January 2014 and July 2014, and among all ICU patients in the same period. Causes of missed diagnosis, doctor awareness and risk factors for missed diagnosis of AKI. Results: (1) the incidence of AKI in our center was 2.80, the ratio of male to female was 2.1: 1, the average age was (60.35 卤16.75) years old, the rate of missed diagnosis of AKI was 65.4 and the understanding rate of AKI was 40.9. The incidence of AKI in patients with ICU was 58.3%. The ratio of male to female was 2.3: 1, with an average age of (61.44 卤16.67) years. (2) univariate analysis showed that: cerebrovascular disease, other heart diseases, multiple organ failure, sepsis. The history of 尾-lactams and antipyretic and analgesic drugs were the risk factors of missed diagnosis in patients with AKI in the late stage of malignant tumor. Multiple organ failure, sepsis, advanced malignant tumor, acute respiratory distress syndrome, tracheal intubation ventilator therapy, shock are the risk factors of AKI in ICU patients. (3) the results of logistic stepwise regression model showed that cerebrovascular disease, advanced malignant tumor, multiple organ failure, sepsis, history of 尾 -lactams and antipyretic and analgesic drugs were independent risk factors for missed diagnosis in patients with AKI. Multiple organ failure, sepsis and shock were independent risk factors for AKI in patients with ICU, and advanced malignant tumors were protective factors. Conclusion: (1) the history of cerebrovascular disease, multiple organ failure, sepsis, antipyretic and analgesic drugs are independent risk factors for missed diagnosis in AKI patients. (2) multiple organ failure, sepsis and shock were independent risk factors for the occurrence of AKI in patients with ICU. Advanced malignant tumor was the protective factor affecting the occurrence of AKI in ICU patients.
【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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