急诊室社区获得性急性肾损伤的临床分析

摘要

Objective To analyze the etiology and risk factors of community acquired acute kidney injury ( CA -AKI ) in Emergency Department.Methods 161 patients with CA -AKI that visited our Emergency Department from May 2013 to Aug 2014 were enrolled in this retrospective study. Clinical data and laboratory test results were collected.The etiology of the patients and prognostic factors were analyzed.Results 161 patients (88 males and 73 females) were enrolled in this study.23.6%patients (38 cases) were less than 35 years old, 33.5%(54 cases) between 35 and 60 years old, and 42.9%(69 cases) over 60 years old.The major causes were pre-renal factors (57.8%, 93 cases). Infectious diseases, cardiovascular and cerebrovascular diseases were major causes of pre-renal CA-AKI.Drug and glomerulopathy were major causes of renal parenchymal CA-AKI.The major cause of post-renal AKI was urinary stone.Multivariate analysis showed that independent risk factors for death were age, MODS and oliguria.Conclusion The major causes of CA-AKI are pre-renal factors.The important risk factors of death in CA-AKI patients are age, MODS and oliguria.%目的：探讨就诊于急诊室的社区获得性急性肾损伤（ community acquired acute kidney injury， CA－AKI）的发病及预后情况，寻找与预后相关的危险因素，为临床更好地认识和预防CA－AKI、改善预后提供临床依据。方法对2013－05－01～2014－08－31就诊于北京大学第一医院急诊科的161例CA－AKI患者的临床资料进行回顾性分析，调查其临床特点及转归情况，分析CA－AKI的危险因素。结果符合入选标准的CA－AKI患者共161例，男88例，女73例；青年组（≤34岁）38例，占23．6％；中年组（35～59岁）54例，占33．5％；老年组（≥60岁）69例，占42．9％。肾前性93例（占57．8％），病因以感染相关性疾病及心脑血管疾病多见；肾性47例（占29．2％），以药物及肾小球疾病多见；肾后性21例（占13．0％），以尿路结石多见。161例CA－AKI患者中有42例死亡。 Logistic回归分析显示，年龄、少尿和多脏器功能障碍综合征（ MODS）是CA－AKI患者死亡的独立危险因素。结论 CA－AKI可由多种病因所导致，其中最常见的是肾前性因素，患者预后与年龄、少尿及MODS密切相关。