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目的观察并比较合并多器官功能障碍(multiple organ Ddysfunction syndrome,MODS)的急性肾损伤(acute kidney injury,AKI)患者的临床及预后特点,并分析AKI患者合并MODS的危险因素。方法回顾性分析上海瑞金医院1997~2010年间住院患者中合并MODS的130例AKI患者的临床病例资料,并与同期收集的910例未合并MODS的AKI患者进行比较分析。结果合并MODS的患者占同期AKI患者的12.5%,和NonMODS组相比,年龄高于NonMODS组(55.57±20.16 vs.49.57±19.90,P=0.001),性别比例无明显差异;RIFLE分级有显著统计学差异,偏向更高严重等级(χ2=24.193,P<0.001),接受RRT的比例明显高于对照组,有显著统计学差异(χ2=52.237,P<0.001);MODS-AKI患者肾功能恢复率为28.5%,明显低于NonMODS组(χ2=94.271,P<0.001),死亡率达70%,和对照组相比有明显统计学意义(χ2=256.152,P<0.001),但预后和RIFLE分级及RRT情况无明显相关,和MODS数目呈正相关(r=0.406,P<0.001);并发MODS危险度最高的因素为机械通气(P<0.001,OR=14.966),其余依次为低血压(P<0.001,OR=5.422)、急性胰腺炎(P=0.004,OR=3.995)、充血心力衰竭(P<0.001,OR=3.527)、败血症(P=0.018,OR=3.357)、发热(P=0.001,OR=2.477)、CKD(P<0.001,OR=0.355),但CKD是否在该过程中扮演保护性角色尚需进一步研究来证实。结论 AKI患者中并发MODS的人群年龄偏高于NonMODS者,性别比例无特殊,RIFLE标准在评估MODS-AKI的预后方面有局限性,RRT在改善MODS-AKI的预后方面的作用本研究未能证实。合并MODS的AKI患者在临床上有其自身特点,要区别于普通AKI而对待。当AKI患者进行机械通气或合并血流动力学改变、感染及急性胰腺炎等急性损伤因素时MODS的发生率增高,因此要注意严密监测上述情况相关指标预防MODS的发生以改善AKI患者预后。
Objective To observe and compare the clinical and prognostic features of patients with acute kidney injury (AKI) complicated with multiple organ dysfunction syndrome (MODS) and to analyze the risk factors associated with MODS in patients with AKI. Methods Clinical data of 130 AKI patients with MODS in Shanghai Ruijin Hospital from 1997 to 2010 were retrospectively analyzed and compared with 910 AKI patients without MODS collected in the same period. Results Compared with NonMODS group, MODS patients with MODS accounted for 12.5% of the patients with AKI in the same period, and the age was higher than that of NonMODS group (55.57 ± 20.16 vs.49.57 ± 19.90, P = 0.001). There was no significant difference in sex ratio; RIFLE grade was statistically significant (Χ2 = 24.193, P <0.001). The proportion of patients receiving RRT was significantly higher than that of the control group (χ2 = 52.237, P <0.001). The recovery of renal function in patients with MODS-AKI (Χ2 = 256.152, P <0.001), but the prognosis and RIFLE were significantly lower than those in NonMODS group (χ2 = 94.271, P <0.001) (R = 0.406, P <0.001). The highest risk of concurrent MODS was mechanical ventilation (P <0.001, OR = 14.966), followed by hypotension (P (P = 0.001, OR = 5.422), acute pancreatitis (P = 0.004, OR = 3.995), congestive heart failure (P <0.001, OR = 3.527), sepsis , OR = 2.477), CKD (P <0.001, OR = 0.355). However, whether CKD plays a protective role in the process needs further study to confirm. Conclusions The age group of MODS patients with AKI is higher than that of NonMODS patients with no specific sex ratio. The RIFLE standard has limitations in assessing the prognosis of MODS-AKI and the role of RRT in improving the prognosis of MODS-AKI. The study failed to confirm . AKI patients with MODS have their own clinical features, to be different from ordinary AKI treatment. When AKI patients with acute injury factors such as mechanical ventilation or combined with hemodynamic changes, infection and acute pancreatitis increased the incidence of MODS, we should pay attention to closely monitoring the above indicators related to the prevention of MODS in order to improve the prognosis of AKI patients.