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find Keyword "急性肾损伤" 79 results
  • Comparison of APACHEⅡ and Ⅲ Scoring System in Predicting the Prognosis of Patients with Acute Kidney Injury and Multiple Organ Dysfunction Syndrome in ICU

    Objective To compare the clinical value of Acute Physiology and Chronic Health Evaluation ( APACHE) Ⅱ / Ⅲ scoring system in predicting the prognosis of patients complicated with acute kidney injury ( AKI) and multiple organ dysfunction syndrome ( MODS) in ICU. Methods 318 patients with AKI and MODS treated with continuous blood purification in ICU fromJanuary 2004 to June 2010, were evaluated with APACHE Ⅱ and APACHEⅢ and analyzed retrospectively. The area under the receiveroperating characteristic curve ( AUC) and the Lemeshow-Hosmer goodness-of-fit of APACHEⅡ and Ⅲ were assessed. Results Mean scores and predicted hospital mortality of APACHEⅡ and Ⅲ were all significantly lower in the survival group than those in the non-survival group ( P lt; 0. 01) . The AUC were 0. 782 for APACHEⅡ, and 0. 755 for APACHEⅢ, with Youden’s indexes of 46. 4% and 36. 7% , respectively. Hosmer-Lemeshow test showed the calibration of the two systems was reasonable. Conclusion APACHEⅡ and Ⅲ are both good for predicting the severity and prognosis of patients complicated with AKI and MODS in ICU but APACHEⅡ is superior in clinical practice.

    Release date:2016-09-13 04:06 Export PDF Favorites Scan
  • Clinical Predictive Score for Acute Kidney Injury after Cardiac Surgery in Adults

    Objective To analyze risk factors of acute kidney injury (AKI) after cardiac surgery in adults and develop a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively analyzed. According to whether they had postoperative AKI,all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients (40.2%) with a mean age of 58±12 years,including 1 004 male patients (71.4%). The non-AKI group was consisted of 2 093 patients (59.8%) with a mean age of 55±13 years,including 1 259 male patients (60.2%). Predictive score system of postoperative AKI was established by univariate analysis between the AKI and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed:male gender (2 points),every 5 years older than 60 years (1 point),diabetes mellitus (2 points),preoperative use of angiotensin converting enzyme inhibitor or angiotensin AT1 receptor blocker (1 point),every 10 ml / (min·1.73 m2) of preoperative estimated glomerular filtration rate (eGFR) under 90 ml / (min·1.73m2) (1 point),preoperative NYHA class Ⅳ (3 points),cardiopulmonary bypass time>120 minutes (2 points),intraoperative hypotension duration>60 minutes (2 points),postoperative hypotension duration>60 minutes (3 points),postoperative peak dosage of intravenous furosemide>100 mg/day (3 points),postoperative peak dosage of intravenous furosemide 60-100 mg/day (2 points),and postoperative mechanical ventilation time>24 hours (2 points). The predictive score system presented a good discrimination ability with the area under the receiver operating characteristic(ROC)curve of 0.738 with 95% CI 0.707 to 0.768,while it also presented a good calibration with Hosmer-Lemeshow statistic (P=0.305). Conclusion A clinical predictive score system for AKI after cardiac surgery in adults is established,which may help clinicians implement early preventive interventions.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Application of Acute Kidney Injury Criteria and Classification to Predict Mortality Following Cardiovascular Surgery

    Abstract: Objective To evaluate the incidence and prognosis of postoperative acute kidney injury (AKI) in patients after cardiovascular surgery, and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network (AKIN) definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine, Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative, intraoperative, and postoperative risk factors related to AKI. Results Among the 1 056 patients, 328 patients(31.06%) had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients (11.59% vs. 0.69%, P<0.05). Multivariate logistic regression analysis suggested that advanced age (OR=1.40 per decade), preoperative hyperuricemia(OR=1.97), preoperative left ventricular failure (OR=2.53), combined CABG and valvular surgery (OR=2.79), prolonged operation time (OR=1.43 per hour), postoperative hypovolemia (OR=11.08) were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 (95% CI 0.801-0.929). Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age, preoperative hyperuricemia, preoperative left ventricular failure, combined CABG and valvular surgery, prolonged operation time, postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery, which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Analysis of Risk Factors for Acute Kidney Injury after Aortic Arch Replacement Surgery

    Abstract: Objective To determine the risk factors for acute kidney injury (AKI) after thoracic aortic arch replacement surgery under deep hypothermic circulatory arrest (DHCA). Methods We retrospectively analyzed the clinical data of 139 patients who underwent thoracic aortic arch replacement surgery under DHCA between January 2004 and December 2008 in Beijing Anzhen Hospital Affiliated to Capital University of Medical Sciences. The patients were divided into two gro-ups according to whether AKI occurred after thoracic aortic arch replacement surgery. In the AKI gro-up (n=48), there were 39 males and 9 females with an age of 57.67±9.56 years. In the normal renal function gro-up (n=91), there were 69 males and 22 females with an age of 41.30±13.37 years. We observed the clinical data of the patients in both gro-ups, including left ventricular ejecting fraction (LVEF) before operation, diameter of the left ventricle, diameter of the ascending aorta, renal function, cardiopulmonary bypass time, aortic crossclamp time, and DHCA time. The risk factors for AKI and death after operation were evaluated by univariate analysis and stepwise logistic regression analysis. Results Among all the patients, AKI occurred in 48 (34.53%), 17 (12.23%) of whom underwent continuous renal replacement therapy (CRRT). Respiratory failure occurred in 27 patients (19.42%). Twentynine patients (20.86%) had cerebral complications, including temporary cerebral dysfunction in 26 patients and permanent cerebral dysfunction in 3 patients. In all the patients, 14 (10.07%) died, including 4 patients of heart failure, 9 patients of multiple organ failure, and 1 patient of cerebral infarction. There were 3 (3.30%)deaths in the normal renal function gro-up and 11 (22.92%) deaths in the AKI gro-up with a significant difference of mortality rate between the two gro-ups (P=0.011). A total of 118 patients were followed -up and 7 were lost. The follow-up time was from 5 to 56 months with an average time of 42 months. During the follow-up period, 7 patients died, including 3 patients of heart failure, 2 patients of cerebral apoplexy, and 2 patients of unknown reasons. The logistic regression analysis revealed that creatinine level was greater than 13260 μmol/L before operation (OR=1.042, P=0.021) and respiratory failure (OR=2.057, P=0.002) were independent determinants for AKI after the operation. Conclusion AKI is the most common complication of thoracic aortic arch replacement surgery under DHCA, and is the risk factor of mortality after the surgery. It is important to enhance perioperative protection of the renal function.

    Release date:2016-08-30 05:56 Export PDF Favorites Scan
  • The Influence of Fish Bile on the Renal Function of Rabbits and Preliminary Study on Its Mechanism

    目的 探讨鱼胆汁对兔肾脏的影响及其机制。 方法 将实验新西兰大耳白兔随机分为灌胃组(GP组,n=19)与静脉注射组(VI组,n=15),根据体重分别按3 mL/kg、0.3 mL/kg的剂量通过灌胃或耳缘静脉注射方式给予鱼胆汁。采集鱼胆汁处理前与处理后1~5 h的血标本,测定肾功能、酸碱平衡及电解质指标,记录GP组每个采样点前20 min尿量及鱼胆汁处理前、处理后5 h的尿常规。鱼胆汁处理后5 h处死动物取肾做病理学检查。 结果 给予一定量鱼胆汁后5 h内,两组兔血肌酐(Scr)、尿素氮、K+呈升高趋势(P均<0.05),而血HCO3?浓度呈下降趋势(P<0.05),其中VI组兔Scr、血K+改变早于GP组。GP组记录尿量明显下降,尿pH值升高,蛋白定量试验、隐血试验结果均呈阳性。两组兔肾组织病理检查均显示肾小球血管充盈,少量中性粒细胞浸润;肾小管水肿及间质充血,部分有局灶性出血,肾间质损伤较肾小球更为严重。 结论 无论经由消化道还是血管给予实验兔鱼胆汁均可导致急性肾功能损伤,与鱼胆汁造成急性肾实质损伤、特别是肾小管间质损伤有关。

    Release date:2016-09-08 09:16 Export PDF Favorites Scan
  • 慢性阻塞性肺病并发急性肾损伤的临床分析

    【摘要】 目的 总结慢性阻塞性肺疾病(COPD)并发急性肾损伤(AKI)的发病机制、临床特点及救治经验。 方法 回顾性分析2008年收治的COPD并发AKI的80例患者的临床资料,初步分析其临床表现、并发症、呼衰程度与AKI的关系,治疗措施与预后的关系。 结果 80例COPD并发的AKI治愈46例(57.5%),好转16例(20%),转为CKD3例(3.75%),死亡15例(18.75%)。 结论 COPD患者是AKI的高危人群,发病率高,并发AKI后易发生多器官功能衰竭(MOF),死亡率增加。早期积极治疗可使多数患者发生的AKI逆转。对于COPD患者避免诱发加重因素,早期识别和早期干预AKI十分重要。

    Release date:2016-09-08 09:50 Export PDF Favorites Scan
  • Clinical Characteristics of Acute Kidney Injury in Hospitalized Patients with Chronic Obstructive Pulmonary Disease

    ObjectiveTo investigate the role on adverse prognosis and risk factors of acute kidney injury (AKI) in hospitalized patients with chronic obstructive pulmonary disease (COPD). MethodsClinical data from hospitalized patients with COPD between January 2009 and June 2012 were studied retrospectively.AKI was diagnosed and classified by AKIN criterion. ResultsThree hundred and sixty-nine patients were enrolled,among whom 69(18.6%) were complicated with AKI.The patients with AKI were older,and had higher levels of hemoglobin,hematocrit value and sodium concentration,and higher rates of comorbidities of diabetes mellitus,proteinuria and shock,compared with the controls.Those with AKI had a 24.1% increased risk for ventilator,121.5% for intensive care,and 89.8% for death.And a higher AKI grade was related to a worse prognosis.The increased risk of AKI was 142.1% for every 5-year increase of age,155.7% for every 0.1 increase of hematocrit value,70.5% for every 0.1 increase of sodium concentration,and 49.1%,89.2%,148.2% and 685.7% for being complicated with proteinuria,coronary artery disease,diabetes mellitus and shock. ConclusionAKI is associated with adverse prognosis in hospitalized patients with COPD.Age,proteinuria,increased levels of hematocrit value and sodium concentration,and comorbidities of coronary artery disease,diabetes mellitus and shock are independent risk factors for AKI

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  • 血液灌流联合连续性静脉-静脉血液滤过治疗脓毒血症合并急性肾损伤的护理

    目的探讨血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)治疗脓毒血症合并急性肾损伤(AKI)的护理。 方法对2011年7月-2013年7月收治的48例脓毒血症合并AKI的患者进行HP联合CVVH治疗。比较治疗前后的血肌酐(Cr)、血尿素氮(BUN)和外围血小板计数(PLT)差异,并分析处理治疗过程中产生的护理问题。 结果48例患者行HP联合CVVH治疗后,Cr由(311.90±183.06)μmol/L降至(108.51±43.93)μmol/L,BUN由(18.21±8.58)mmol/L降至(8.51±2.64)mmol/L,PLT由(94.68±30.40)×109/L降至(131.61±39.79)×109/L,差异均有统计学意义(P<0.05)。5例(10.42%)死亡,33例(68.75%)好转出院,10例(20.83%)肾功能恢复转入普通病房。 结论HP联合CVVH治疗脓毒血症合并AKI,能有效改善患者的肾功能,而高质量的护理有助于治疗的顺利完成。

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  • 华法林相关肾病

    华法林相关肾病(WRN)是一种最近被认知的疾病。2009年美国俄亥俄州立大学发现在接受华法林治疗的患者,治疗过程中可以引起急性肾损伤。他们考虑到这种急性肾损伤可能是华法林治疗的一种以前未知的并发症,即WRN。其具体发病机制目前仍未明确,未来针对其具体发病机制仍需要更多的研究。目前一般认为急性肾小管损伤、肾小球毛细血管袢断裂,脱落红细胞阻塞肾小管仍然是WRN 的主要发病机制。动物实验表明维生素K 可以阻止WRN 进展,然而临床上对其仍未有明确的治疗方法。WRN患者的病死率高,故在华法林治疗期间密切监测国际标准化比值及血肌酐值,以便早期诊断及及时治疗。正确的认知WRN 的临床特征,对降低患者病死率和及时的临床干预有重要意义。

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  • Effectiveness of Continuous Renal Replacement Therapy of Acute Kidney Injury after Type A Aortic Dissection Surgery: A Case Control Study

    ObjectiveTo evaluate the efficacy of the continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) after the surgery of type A aortic dissection. MethodsWe retrospectively analyzed 58 hemodialysis patients with AKI after type A aortic dissection surgery in our hospital between January 2003 and January 2014.The 58 patients were divided into two groups including a bedside intermittent hemodialysis (IHD) group and a CRRT group based on the methods of hemodialysis. There were 38 patients with 29 males and 9 females at average age of 49.8± 13.7 years in the CRRT group. There were 20 patients in the IHD group with 14 males and 6 females at average age of 52.6± 11.0 years. ResultsCompared with IHD, CRRT had significantly greater effect on reducing the simplified acute physiology scoring system (SAPS)Ⅱscore (Ftime=60.964, P=0.000; Ftime * group=3.178, P=0.041). However, there was no significant difference in reducing the acute tubular necrosis individual illness severity index (ATN-ISI) score between the two groups (Ftime=13.803, P=0.000; Ftime * group=0.222, P=0.951). Lower incidences of dialysis-related complications including hypotension (P=0.027) and acute congestive heart failure (P=0.011) were found in the CRRT group. There was no statistical difference in operation time (P=0.367) between the two groups. While statistical differences in duration of hospitalization in intensive care unit (P=0.006), in hospital time (P=0.047), frequency of dialysis (P=0.001), and dialysis time (P=0.039) were found between the two groups. However there were no significant differences in mortality during hospital (P=0.544)and incidences of recovery (P=0.056) between the two groups. ConclusionCompared with IHD, CRRT had significantly positive effect on patients who suffered from AKI after type A aortic dissection surgery, which can help reduce incidences of dialysis-related complications, duration and cost of hospitalization in ICU.

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