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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。
Objective To understand the incidence and mortality of acute kidney injury (AKI) after trauma and to analyze the risk factors influencing the occurrence and prognosis of AKI. Methods A retrospective clinical study was conducted to screen 4 221 trauma patients admitted to the People’s Liberation Army 309 Hospital between January 2004 and January 2014. The incidence of AKI and mortality were calculated and multivariate logistic method was used to analyze the risk of AKI occurrence and prognosis factor. Results According to the diagnosis and classification criteria of KDIGO, the incidence of AKI was 11.6% (489/4 221), and the hospital mortality was 46.0% (225/489). The more serious the AKI, the higher the hospital mortality In-hospital mortality was 30.1% (84/279), 54.6% (53/97) and 77.9% (88/113) in patients with KDIGO grade 1, 2 and 3, respectively. Multivariate logistic regression analysis showed that age, admission acute physiology and chronic health assessment Ⅱ (APACHEⅡ) score> 17, admission injury severity score (ISS)> 16, severe head injury, abdominal organ injury, rhabdomyolysis, shock, Respiratory dysfunction was a risk factor for AKI (P <0.01), hospital admission ISS> 25, severe head injury, KDIGO level 3 and cardiovascular, respiratory dysfunction were risk factors for AKI death (P <0.05, P <0.01). Conclusion The incidence of AKI after trauma and the high mortality rate, prevention of serious complications is the key to improve prognosis.