医院获得性急性肾功能衰竭的病死危险因素分析调查及临床对策

目的调查医院获得性急性肾功能衰竭(肾衰)的病死率及死亡危险因素。方法回顾性调查1991～1996年的1056例危重病患者，利用队列研究方法对医院获得性急性肾衰患者死亡危险因素进行分析。结果1　056例危重病患者中，143例发生急性肾衰，病死率64.34%。患者平均APACHEⅡ评分(24.20±8.53)分，而Liano急性肾衰预后评分(ATNISS)为(72.46±25.58)%。单纯急性肾衰的住院病死率为0，而急性肾衰合并肾外器官衰竭数目越多，患者的病死率越高。合并1个肾外器官衰竭者病死率25.00%，2个肾外器官衰竭者为47.62%，3个肾外器官衰竭者为81.58%，而发生4个肾外器官功能衰竭者病死率达90.20%。22个因素参与急性肾衰死亡危险因素的单因素分析，结果显示年龄(>60岁)、免疫功能低下、APACHEⅡ评分(>20分)、非手术、全身性炎症反应的程度、严重全身性感染、感染性休克、器官衰竭数目、机械通气、昏迷、低血压、黄疸及少尿等因素均与急性肾衰死亡关系显著(P均<0.05)。急性肾衰患者的最常见的直接病死原因是顽固性感染性休克(46.74%)。结论充分认识急性肾衰死亡的危险因素，并积极控制机体炎症反应，防治多器官功能衰竭，可能是降低急性肾衰病死率的关键。

An analysis of risk factors and therapeutic strategies in hospitalacquired acute renal failure

Objective:To study the mortality of hospitalacquired acute renal failure and risk factors in critically ill patients.Methods:Univariate analysis was performed to identify risk factors associated with hospitalacquired acute renal failure.Results:In 1 056 critically ill patients,acute renal failure occurred in 143 patients.The overall mortality of the patients with acute renal failure was 64.34%.The APACHEⅡ score and Liano ATNISS were 24.20±8.53 and (72.46±25.58)%,respectively.The mortality of patients with acute renal failure alone was 0,but mortality in patients of acute renal failure accompanied by one,two,three and four nonrenal organ failure were 25.00%,47.62%,81.58% and 90.20%,respectively.Univariate analysis identified the following risk factors:age (>60),immunocompromise, APACHE Ⅱ score (>20),nonoperation, the degree of systemic inflammatory response syndrome, severe sepsis, septic shock, number of failed organ, mechanical ventilation, coma, hypotension, jaundice, and oliguria. Refractory septic shock was the predominant factor leading to death in acute renal failure.Conclusions:The mortality of acute renal failure remains high in ICU, and prevention of risk factors may play a key role in the reduction of acute renal failure mortality in critically ill patients.