摘要
目的研究内科病房≥60岁患者社区获得性急性肾损伤(CA-AKI)的临床特点及相关用药情况。方法回顾性分析内科病房老年患者的临床资料。按全球肾脏病预后组织(KDIGO)标准,根据门诊及住院后血肌酐变化情况将研究人群分为CA-AKI组以及非急性肾损伤组。分析两组患者的临床特点及可疑肾毒性药物的使用。结果老年内科住院患者中符合CA-AKI 2371例,比例为6.51%。CA-AKI组慢性基础疾病的比例及Charlson并发症指数更高。发生AKI后,氨基糖苷类抗生素、糖肽类抗生素、抗真菌药、β内酰胺类抗生素、利尿剂及脱水剂、铁剂、肾上腺素受体激动剂、抗心力衰竭药及3种以上药物的使用比例在CA-AKI组更高。CA-AKI组患者住院期间合并心源性休克(CS)(1.61%比0.05%)和多器官功能障碍综合征(MODS)(5.99%比0.04%)比例均高于非AKI组(P<0.05),需要心肺复苏(6.03%比0.29%)、转ICU(21.13%比4.27%)、血液透析(10.42%比0.003%)及病死率(9.71%比0.43%)更高(P<0.001);住院天数[(14.46±6.85)d比(8.30±5.43)d]及住院费用[(6.12±5.61)万元比(3.81±3.54)万元]也明显增加(P<0.001)。随着CA-AKI发生后可疑肾毒性药物使用的数量增多,临床转归及预后呈现更加不良的趋势(P<0.001)。结论老年CA-AK的发生比例较高,存在更多的基础疾病,发生AKI后继续使用可疑肾毒性药物的情况仍较普遍,患者住院期间临床转归及预后更差。肾毒性药物使用种类增加有加重病情的趋势。
Objective To explore the clinical characteristics and related medications of hospital-acquired acute kidney injury(CA-AKI)elderly patients(age≥60).Methods The clinical data of patients in geriatric wards were retrospectively analyzed.According to the kidney disease:improving global outcomes criteria,CA-AKI was classified based on the changes in serum creatinine.The study population was divided into CA-AKI group and non-AKI group.Results Among 2371 patients with CA-AKI,the incidence of CA-AKI was 26.03%.In CA-AKI group,the chronic comorbidities and Charlson comorbidity index(CCI)score≥3 was higher than in non-AKI groups(P<0.001).After the onset of CA-AKI,physicians continued to use most suspected nephrotoxic drugs.Patients in the CA-AKI group have higher percentage of cardiogenic shock(CS,1.61%vs.0.05%)and multiple organ failure(MODS,5.99%vs.0.04%)during hospitalization(P<0.05),as well as transferring to the ICU(21.13%vs.4.27%),CPR(6.03%vs.0.29%),hemodialysis(10.42%vs.0.003%)and in hospital mortality(9.71%vs.0.43%,P<0.001).In addition,the hospitalization day(14.46±6.846 vs.8.30±5.43)and cost(6.12±5.61 vs.3.81±3.54)also increased in the CA-AKI group(P<0.001).Moreover,it was observed that clinical outcomes and prognosis of CA-AKI patients tended to increase with the use of the number of nephrotoxic drugs after the disease onset(P<0.001).Conclusion The incidence of elderly CA-AK is relatively high with more complex chronic complications.It is quite common to continue to use other suspected nephrotoxic drugs after AKI.The clinical outcomes and prognosis of CA-AKI patients are worse during hospitalization,and it tended to increase with the use of nephrotoxic drugs after the onset.
作者
余枫
连兴基
陈源汉
林洁珊
吴燕华
胡文学
刘伟
郝文科
Yu Feng;Lian Xingji;Chen Yuanhan;Lin Jieshan;Wu Yanhua;Hu Wenxue;Liu Wei;Hao Wenke(Department of Nephrology,Guangdong Provincial People's Hospital,Guangdong Institute of Geriatrics,Guangdong Academy of Medical Sciences,the First Hospital of South China Unitersity of Technology,Guangzhou 510080,China)
出处
《中国临床保健杂志》
CAS
2020年第6期756-761,共6页
Chinese Journal of Clinical Healthcare
关键词
急性肾损伤
社区获得性感染
药物相关性副作用和不良反应
预后
老年人
Acute kidney injury
Community-acquired infections
Drug-related side effects and adverse reactions
Prognosis
Aged
