单中心急性肾损伤患者漏诊原因的回顾性研究∗

摘要

目的：：回顾性分析我院收治的356例急性肾损伤漏诊患者的漏诊原因，以提高临床医生对急性肾损伤的认识和诊断水平，从而减少漏诊率。方法：从2014年1月和2014年7月我院全部住院患者中根据改善全球肾脏病预后组织KDIGO 临床实践指南的诊断标准，诊断为急性肾损伤的患者，回顾性分析急性肾损伤的发生率，漏诊率，漏诊原因，医生知晓率，以及引起急性肾损伤漏诊的危险因素。结果：(1)住院患者急性肾损伤的发病率为2．80%(544／19528)，患者男女比例2．1∶1，平均年龄(60．35±16．75)岁；(2)544例急性肾损伤患者中，漏诊356例，总的漏诊率为65．4%；(3)单因素分析结果显示：脑血管史、其他心脏疾病史、多器官功能衰竭史、脓毒血症史，恶性肿瘤晚期、β-内酰胺类药物史、解热镇痛药物史(均P <0．05)是急性肾损伤患者漏诊的危险因素；logistic 逐步回归模型结果提示，脑血管史、恶性肿瘤晚期、多器官功能衰竭史、脓毒血症史、β-内酰胺类药物史、解热镇痛药物史是影响急性肾损伤患者漏诊的影响因素(均 P <0．05)。结论：脑血管史、多器官功能衰竭史、脓毒血症史、解热镇痛药物史是急性肾损伤患者漏诊的独立危险因素。β-内酰胺类药物史、恶性肿瘤晚期史是急性肾损伤降低漏诊率的保护性因素。%Objective:In order to raise awareness and clinical diagnosis of acute kidney injury and reduce the omission diag-nosis rate, we retrospectively analyzed the reason of the omission diagnosis rate from 356 patients who were admitted to the First Affili-ated Hospital of Xinjiang medical university. Methods:The acute kidney injury was diagnosed by KDIGO global clinical practice guidelines. We were chosen all the AKD patients in our hospital from January 2014 to July 2014. Retrospectively analyzed the inci-dence of acute kidney injury, the omission diagnosis rate, omission reason, doctors awareness, and the risk factors of omission diagno-sis about acute kidney injury. Results:(1)The incidence rate of hospitalized patients with acute kidney injury rate was 2. 8% (544 /19 528), the proportion of male and female patients was 2. 1∶ 1, the average age was (60. 35 ± 16. 75) years old. (2) Among 544 cases of acute kidney injury patients, 356 cases were omission diagnosis. The total omission diagnosis rate was 65. 4% . (3)Univari-ate analysis indicated that cerebrovascular disease, heart disease, multiple organ failure, sepsis, malignant tumor, taking β - lactams anti - inflammatory drugs (all P < 0. 05) were the factors to the acute kidney injury patients been missed; Logistic regression model to analyze risk factors for acute kidney injury patients missed, indicated that the cerebrovascular disease, heart disease, multiple organ failure, sepsis, malignant tumor, taking β - lactams anti - inflammatory drugs (all P < 0. 05) were the independent risk factors for a-cute kidney injury in patients missed (all P < 0. 05). Conclusion:Cerebrovascular disease, heart disease, multiple organ failure, sepsis, malignant tumor were the independent risk factors for acute kidney injury patients missed. Taking β - lactams anti - inflamma-tory drugs and malignant tumor were the protective factors for acute kidney injury patients missed.