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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:(1)AKI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%;(2)AKI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%;(3)AKI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。
Objective: To study the incidence, etiology and diagnosis of acute kidney injury (inpatients) with acute kidney injury (AKI). METHODS: A cross-sectional study was conducted in patients who were AKI-defined over the age of 18 admitted to the First Affiliated Hospital of Nanjing Medical University from October 2013 to September 2014. Analysis of hospitalized patients with AKI incidence, etiology, diagnosis and distribution departments. Results: (1) The incidence of AKI was 1.61% (1 401/87 196). The ratio of male to female was 2.03:1. The mean age was 63.2 ± 37.2 years. The urban population accounted for 58.3%. The median length of stay was 18 to 11. ) d, the median hospital costs 5.72 (2.50 ~ 12.16) million. 66.5% patients with complete recovery of renal function during hospitalization and 35.3% patients died after 30 days. (2) The actual detection rate of AKI was 0.76%, the timely diagnosis rate was 44.0%, the delay diagnosis rate was 3.3% and the missed diagnosis rate was 52.7%. The diagnosis rate of AKI in nephrology was the highest (89.3%), the lowest was in surgical patients, the rate of missed diagnosis was 75.1%. (3) The incidence of AKI varied from department to department: 3.5% in nephrology, 1.3% in other internal medicine and 1.0% , And 18.0% were in intensive care unit (ICU). Nephrology, other internal medicine, surgery and ICU were 7.4%, 37.1%, 30.1% and 25.4% respectively in patients with AKI. Cardiology, Hematology, Surgery, ICU is the relative risk of AKI department; (4) according to the AKI etiology, prerenal renal, renal and post-renal accounted for 42.1%, 52.2%, 5.7%; of which pre-young group of young patients with a high proportion of basic (5) In this study, 38.0%, 22.1% and 40.0% of patients with stage 1, stage 2 and stage 3 AKI, respectively. The higher the stage of AKI, the higher the rate of timely diagnosis , The lower the rate of misdiagnosis, but the longer ICU stay, the worse the recovery of renal function, the higher the 30-day mortality. Conclusion: AKI is more common in hospitalized patients, the detection rate is low and the rate of missed diagnosis is high. The physicians should strengthen the learning of AKI diagnostic criteria and the identification of risk factors, establish an early warning system for AKI, and early detection and diagnosis to improve the prognosis of AKI.