摘要
目的探讨急诊危重病监护室（EICU）患者并发急性肾损伤（acute kindy injury，AKI）的病因、临床特点及影响预后的因素。方法回顾性分析本院2006—12～2009—04入住EICU的190例AKI患者的临床资料，分析其病因、临床特点及影响预后的危险因素。结果190例AKI患者中，男性131例（68．94％），女性59例（31．05％），平均年龄（59．64±18．39）岁。肾前性病因最常见，占78，95％，其中基础病因以心血管疾病最多见，其次为感染相关性疾病等。肾性病因主要以慢性肾脏疾病合并其他并发症，其次为急性中毒、横纹肌溶解综合征等。肾前性AKI死亡率60％，显著高于其他两组（P〈0．05）。各种病因在各年龄组分布比较差异无统计学意义。老年组蛋白尿、血尿、高血压、糖尿病与中青年组比较差异有统计学意义，基础病因在各年龄组比较差异有统计学意义。老年组器官衰竭数目显著少于中青年组（P〈0．05）。生存组83例，死亡组107例.单因素分析显示，少尿、器官衰竭数目、AKI分期是影响预后的因素。多因素Logistic 回归分析显示，器官衰竭数目是影响预后的因素。结论在EICU的重症患者中，心脑血管疾病、重症感染、多发伤等肾前性病因引起的AKI较常见，要及早诊断并积极干预，从而改善患者的预后。一旦进展到AKI后期时，注意防治多器官衰竭的发生。
Objective To analyze the etiologies,clinical characteristics and prognostic factors of 190 cases with acute kidney injury （AK1）in Emergency Intensive Care Unit. Methods This retrospective study included clinical data of 190 patients with AKI in our department from December 2006 to April 2009. The etiologies ,clinical characteristics and prognostic factors were analyzed. Results There were 131 males and 59 females with mean ages （59.64 ± 18.39）years old. The major cause of AKI was pre - renal AKI （78.95%）. Cardiovascular and cerebrovascular diseases, infectious diseases were major causes of pre - renal AKI. Multiple etiologic factors of underlying chronic disease, intoxication were major canses of renal parenchymal. Mortality of pre - renal AKI were higher than renal parcnchymal and post renal AKI（P 〈 0.05）. The mortality of AKI in our study was 60.00%. There were no significant differences in etiology among different age groups, the proportion of the elderly group with proteinuria, hematuria, hypertension and diabetes mellitus were higher than those of young and middle - aged groups. There were apparent differences in the sub - etiology among different groups, the number of organ failures in the elderly group were less than those in young and middle - aged groups （ P 〈 0.05 ）. Univariate analysis showed that prognosis was correlated with oliguria, the staging of AKI, the number of organ failure. The multivariable Logistic regression showed that the number of organ failure was the predictor of mortality. Conclusion Patients with cardiovascular and cerebrovascular diseases, infectious diseases and trauma are prone to pre - renal in Emergency Intensive Care Unit. Early diagnosis and early treatment play an important role in increasing survival rate. Prevention of MODS is a key management to decrease the mortality in severe AKI.
出处
《中国急救医学》
CAS
CSCD
北大核心
2011年第2期120-124,共5页
Chinese Journal of Critical Care Medicine
基金
浙江省医学扶植重点建设学科计划项目（No.07-F04）
关键词
急诊
急性肾损伤
临床特点
病因
预后
Emergency
Acute kidney injury
Clinical features
Etiology
Prognosis
作者简介
孙杰（1985-），女，硕士研究生。
通讯作者：卢中秋（1964-），男，教授，主任医师，博士生导师，E-mail：lzq640815@163．com。
