| 摘要: |
| 目的 了解创伤后急性肾损伤（AKI）的发生率和病死率，并分析影响AKI发生及预后的危险因素。方法 采用回顾性临床研究方法，筛选2004年1月至2014年1月解放军309医院收治的创伤患者共4 221例，统计AKI发生率和病死率，采用多变量logistic方法分析AKI发生及预后的危险因素。结果 按改善全球肾脏病预后组织（KDIGO）诊断及分级标准，AKI发生率为11.6%（489/4 221），院内病死率为46.0%（225/489）；AKI越严重，院内病死率越高，KDIGO 1级、2级、3级的患者院内病死率分别为30.1%（84/279）、54.6%（53/97）、77.9%（88/113）。多变量logistic回归分析表明，年龄增长、入院急性生理和慢性健康评估Ⅱ（APACHEⅡ）积分 > 17、入院损伤严重评分（ISS） > 16、严重头部伤、腹部脏器伤、横纹肌溶解、休克、呼吸系统功能障碍是AKI发生的危险因素（P<0.01），入院ISS>25、严重头部伤、KDIGO 3级和心血管、呼吸系统功能障碍是AKI患者死亡的危险因素（P < 0.05，P < 0.01）。结论 创伤后AKI发生率和病死率高，预防严重并发症是改善预后的关键。 |
| 关键词: 创伤和损伤 急性肾损伤 KDIGO标准 危险因素 |
| DOI：10.16781/j.0258-879x.2016.11.1431 |
| 投稿时间：2016-04-15修订日期：2016-10-09 |
| 基金项目: |
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| Acute kidney injury after trauma: an analysis of risk factors for incidence and prognosis |
| YUAN Fang1*,XIAN Hui-ling1,LI Bo1,ZHANG Zhi-min2 |
(1. Outpatient Department of Zhantansi, No. 309 Hospital of PLA, Beijing 100034, China;
2. Division of Nephrology, No. 309 Hospital of PLA, Beijing 100091, China
*Corresponding author.) |
| Abstract: |
| Objective To investigate the incidence and mortality of acute kidney injury (AKI) in posttraumatic patients, and to analyze the risk factors influencing the incidence and outcomes of AKI. Methods Totally 4 221 patients with trauma who were admitted to No. 309 Hospital of PLA between Jan. 2004 and Jan. 2014 were screened and subjected to a retrospective study, and the incidence rate of AKI and mortality were analyzed. Multivariate logistic regression analysis was conducted to identify the risk factors for the incidence and prognosis of the patients with AKI. Results The incidence of AKI in posttraumatic patients in this study was 11.6% (489/4 221) according to the classification and diagnosis criteria from Kidney Disease:Improving Global Outcomes (KDIGO), and 46.0% (225/489) of them died prior to hospital discharge. There was an increasing hospital mortality tendency with the increase of AKI severity, with the hospital mortality rates being 30.1% (84/279), 54.6% (53/97), and 77.9% (88/113) in AKI patients with KDIGO 1, 2, and 3 stage, respectively. Multivariate logistic regression analysis showed that increase of age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores on admission > 17, injury severity score (ISS) on admission > 16, severe head injury, abdominal organ injury, rhabdomyolysis, shock and respiration system dysfunction were risk factors for occurrence of AKI (P<0.01). Meanwhile, several factors were significantly related to the death of patients with AKI; they included ISS>25, severe head injury, KDIGO stage 3, cardiovascular and respiratory system dysfunction (P < 0.05,P < 0.01). Conclusion AKI is a common clinical complication with high mortality in posttraumatic patients. To prevent severe complications after trauma is the key for improving the prognosis of patients. |
| Key words: wounds and injuries acute kidney injuries KDIGO criteria risk factors |
