摘要
目的 分析院内非肾科急性肾损伤（AKI）的成年患者漏诊原因,以提高对AKI的认识及诊断水平.方法 入选2012年1月至2013年7月期间在本院住院时发生AKI的患者,回顾性分析AKI的发病率、漏诊率、病因、分布特点及漏诊原因.结果 （1）住院患者的AKI发病率为0.67％（381/56 835）.患者男女比例为1.91∶1,平均年龄为（63.45±16.95）岁.（2）肾前性AKI 321例（84.25％）;肾性42例（11.02％）;肾后性18例（4.72％）.（3）漏诊情况及各科室发生情况：381例AKI中,漏诊189例,总漏诊率为49.61％.其中外科中以神经外科、普外科、心外科AKI漏诊率较高,漏诊率分别为62.96％、59.09％、50.00％;内科中以心内科、呼吸科、神经内科AKI漏诊率较高,漏诊率分别为50.00％、50.00％、45.45％.（4） Logistic逐步回归模型分析影响AKI患者漏诊的危险因素,结果提示,高血压病史（OR=1.631）、肾脏替代治疗（RRT）史（OR=23.256）和少尿史（OR=1.936）是预示AKI患者漏诊的独立影响因素.结论 AKI漏诊率较高,不同科室漏诊率不同.高血压病史、RRT史和少尿史是AKI患者漏诊的独立影响因素.临床医师尤其非肾脏专科医师应提高对AKI的认识和关注,降低AKI漏诊率.
Objective To raise the awareness of acute kidney injury （AKI） and improve the level of diagnosis.Methods All the hospitalized adult patients in the Affiliated People＇s Hospital of Shanxi Medical University from January 2012 to July 2013 were screened.Those patients diagnosed as AKI were retrospectively analyzed in terms of incidence,the rate of missed diagnosis,etiology,distribution and prognosis of AKI.Results （1） The incidence of AKI in the patients was 0.67％ （381/56 835）,the ratio of male to female was 1.91 ∶ 1,and the average age was （63.45±16.95） years.（2）There were 321 cases diagnosed as pre-renal AKI （84.25％）,42 cases diagnosed as renal AKI （11.02％） and 18 cases diagnosed as post-renal AKI （4.72％）.（3）There were 189 cases（49.61％） missed diagnosed among all the screened cases.The rates of missed diagnosis in neurosurgery,general surgery and cardiac surgery department was 62.96％,59.09％ and 50.00％,in cardiology,respiratory and neurology department was 50.00％,50.00％ and 45.45％ respectively.（4） Multivariate Logistic regression analysis showed that hypertension [odds ratio（OR）=1.631],renal replacement therapy（RRT）（OR=23.256） and oliguria history （OR=1.936） were independent risk factors of missed AKI diagnosis.Conclusion The missed diagnosis rate of AKI is high and has certain characteristics in different departments.Hypertension,RRT and oliguria history are independent impact factors of missed AKI diagnosis.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2014年第9期645-649,共5页
Chinese Journal of Nephrology
关键词
肾功能不全
急性
诊断
住院病人
非肾科
漏诊
Renal insufficiency, acute
Diagnosis
Inpatients
Non-nephrology
Missed diagnosis
