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目的分析院内获得性急性肾功能衰竭(HA-ARF)的发生率、相关危险因素和转归。方法对1990-2000年在北京协和医院住院期间发生ARF的成年住院患者进行回顾分析。结果在212例ARF患者中,HA-ARF88例,占41.5%,社区获得性急性肾功能衰竭(community-acquired renal failure,CA-ARF)124例,占58.5%。HA-ARF患者入院时平均血肌酐和尿素氮(BUN)值为(88.4±20.33)μmol/L和(7±3.46)mmol/L,发生ARF后血肌酐和BUN峰值为(433.1±213.92)μmol/L和(29±16.12)mmol/L。HA-ARF可发生于各个科室,但以ICU最多见,占23.6%,而CA-ARF以肾内科最多,占61.3%。在HA-ARF的病因中,最常见的是多脏器功能衰竭(MOF),占40.4%;缺血性因素29例,占32.6%;大手术后19例,占21.6%;药物中毒性肾病12例,占13.6%。在CA-ARF的病因中,最常见的是急性肾小管坏死(acute tubular necrosis,ATN),37例,占29.8%。88例HA-ARF患者中,7例出院,死亡81例,病死率为91%;CA-ARF死亡37例,病死率为29.8%。结论HA-ARF相当多见,其中表现为MOF者占首位,而CA-ARF的病因以ATN最多。在术后HA-ARF患者中,肾前性因素是需要注意的危险因素,而在药物性因素中,抗生素,特别是氨基糖甙类抗生素的应用仍需慎重。HA-ARF的病死率较高与MOF的发生率高有关。
Objective To analyze the incidence, related risk factors and prognosis of acquired acute renal failure (HA-ARF) in hospital. Methods A retrospective analysis of adult inpatients with ARF during hospitalization at Peking Union Medical College Hospital during 1990-2000 was conducted. Results In 212 ARF patients, 88 cases were HA-ARF, accounting for 41.5%. There were 124 cases of community-acquired renal failure (CA-ARF), accounting for 58.5%. The average serum creatinine and blood urea nitrogen (BUN) values were (88.4 ± 20.33) μmol / L and (7 ± 3.46) mmol / L on admission in HA-ARF patients, and the peak values of serum creatinine and BUN were (433.1 ± 213.92) μmol / L and (29 ± 16.12) mmol / L. HA-ARF can occur in various departments, but the ICU is the most common, accounting for 23.6%, while CA-ARF most renal medicine, accounting for 61.3%. The most common causes of HA-ARF were multiple organ failure (MOF), accounting for 40.4%; ischemic factors in 29 cases, accounting for 32.6%; major surgery in 19 cases, accounting for 21.6%; drug-induced nephropathy 12 cases, accounting for 13.6%. The most common cause of CA-ARF was acute tubular necrosis (ATN), 37 cases (29.8%). Of the 88 patients with HA-ARF, 7 were discharged from hospital and 81 died, with a mortality rate of 91%. CA-ARF died in 37 patients and the mortality rate was 29.8%. Conclusion HA-ARF is quite common, of which the performance of the MOF accounted for the first place, while the CA-ARF causes the most ATN. In postoperative patients with HA-ARF, prerenal factors are risk factors that need attention, and in the drug factors, the application of antibiotics, especially aminoglycoside antibiotics still need to be cautious. The higher mortality of HA-ARF is associated with the higher incidence of MOF.