文章摘要
程小燕,邬步云,毛慧娟,邢昌赢.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[J].南京医科大学学报,2017,(3):322~327
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
Epidemiology of acute kidney injury(AKI) in inpatients:a single center retrospective observational study
投稿时间:2016-07-13  
DOI:10.7655/NYDXBNS20170313
中文关键词: 急性肾损伤  住院患者  流行病学  诊断
英文关键词: acute kidney injury (AKI)  hospitalized patients  epidemiology  diagnosis
基金项目:
作者单位
程小燕 南京医科大学第一附属医院肾科江苏 南京 210029 
邬步云 南京医科大学第一附属医院肾科江苏 南京 210029 
毛慧娟 南京医科大学第一附属医院肾科江苏 南京 210029 
邢昌赢 南京医科大学第一附属医院肾科江苏 南京 210029 
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中文摘要:
      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:①AKI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%;②AKI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%;③AKI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。
英文摘要:
      Objective:To investigate the incidence,etiology and diagnosis of acute kidney injury (AKI) in hospitalized patients. Methods:From October 2013 to September 2014,hospitalized patients meeting AKI (KDIGO,2012) definition and beyond 18 years old were screened for a cross-sectional study. The incidence,etiology,diagnosis and departments distributing of AKI patients were analyzed by SAS. Results:(1)The incidence of AKI was 1.6% (1401/87196),male to female ratio was 2.03:1,average age was 63.2±37.2,urban population accounted for 58.3%,the median length of stay was 18 (11,28) days,and median costs was 57.2(25.0-121.6) thousand Yuan. Patients whose renal function recovered completely or partially accounted for 66.5%,and 30 d mortality was 35.3% correspondingly. (2)AKI detection rate,timely diagnosis,delayed diagnosis,and missed diagnosis rate were 0.76%,44%,3.3% and 52.7%,respectively. Renal patients were characterized by highest AKI diagnosis rate (89.3%),while the surgical patients were at the lowest level with missed diagnosis rate of 75.1%. (3) The incidence of AKI varied by different departments:3.5% for nephrologie,1.3% for other internal,1.0% for surgery,and 18% for ICU. Nephrology,other internal,surgery and ICU accounted for 7.4%,37.1%,30.1% and 25.4% of the patients diagnosed with AKI,respectively. Cardiology,hematology,cardiothoracic surgery and ICU had a highrisk of AKI. (4) According to the etiology of AKI,prerenal,renal and post-renal accounted for 42.1%,52.2% and 5.7%,respectively. And prerenal was characterized with higher percentage of young patients with good original renal function; however,the missed diagnosis rate was as high as 85.7%. (5)AKI patients at stage 1,2 and 3 accounted for 38.0%,22.1% and 40.0%,respectively. As AKI stage upgraded,timely diagnosis rate was increased and missed diagnosis rate was decreased,however,it was accompanied by longer AKI stay,worse renal function recovery and higher 30 d mortality. Conclusion:AKI was generally characterized with common occurrence,low detection rate and high missed diagnosis rate. AKI criteria and recognition of high-risk factors needed to be spread among physicians in order to improve prognosis of AKI. Warning system for AKI should be established to improve early detection and diagnosis.
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