RIFLE标准和AKIN标准诊断儿童急性肾损伤的对比研究

发布时间：2018-05-16 17:19

本文选题：急性肾损伤 + 儿童　；参考：《重庆医科大学》2013年硕士论文

【摘要】：目的：探讨RIFLE和AKIN两种分级诊断标准在儿童AKI中的诊断意义，以期对临床AKI患儿的早期诊断、早期干预治疗有所助益。方法：回顾性分析重庆医科大学附属儿童医院2011年1月1日--2011年12月31日收住入院的诊断原发性、继发性肾脏疾病以及肾功能异常的1328例住院患儿的病历资料，筛检出符合AKI诊断标准患儿的临床特征、实验室指标、治疗及病情转归等情况，采用SPSS17.0统计软件进行数据处理分析，探讨RIFLE和AKIN标准两种分级诊断标准在儿童AKI中的诊断意义。结果： 1.在回顾性分析的1328例住院患儿中，符合AKI诊断标准的223例。其中，符合RIFLE分层标准的222例，，达到AKIN分期标准的223例，89例（39.9%）患儿达到ARF标准。 2.223例AKI患儿中，男151例（67.7%），女72例（32.3%）；最大年龄为16岁2月，最小年龄为1小时3分，中位年龄为3岁9月。预后分布中，治愈88例（39.5%），好转80例（35.9%），未愈40例（17.9%），死亡15例（6.7%）。 3.根据RIFLE分层诊断标准，AKI风险期46例（20.7%），损伤期72例（32.4%），衰竭期104例（46.8%）。 4.采用AKIN标准，AKI1期45例（20.2%），2期59例（26.4%），3期119例（53.4%）。 5.与RIFLE标准相比较，AKIN标准在儿童AKI的诊断方面没有明显优势（χ~2=1，P=0.962）。 6.分期诊断方面，AKIN标准1期、2期、3期与RIFLE标准对应的风险期、损伤期、衰竭期无明显统计学差异（P0.05）。 7.无论采用RIFLE标准或AKIN标准，不同AKI分期的预后分布、机械通气率、血液净化率、多器官功能障碍发生率以及急性肾衰竭发生率均有统计学差异。 8．随着AKI严重程度的加重（即分期的加重），院内病死率升高。AKI衰竭期（3期）患儿的院内病死率明显高于风险期（1期）、损伤期（2期），而AKI风险期与损伤期（或1期与2期）患儿的院内病死率差异未达到统计学意义。此外，AKI不同分期的治愈率、平均住院天数的无明显统计学差异。结论： RIFLE分层诊断标准和AKIN标准在儿童AKI的诊断方面没有明显差别。AKIN标准诊断的1期、2期、3期与RIFLE标准对应的风险期、损伤期、衰竭期的近期预后分布无统计学差异，尚不能认为根据两个不同诊断标准进行分期的AKI患儿近期预后有差别。但是，无论是按照RIFLE标准还是AKIN标准进行分期诊断，不同分级AKI患儿的近期预后分布有明显差异，AKI严重程度的加重（即AKI分期的加重）与患儿的近期不良预后密切相关。随着AKI严重程度的加重（分期的加重），AKI患儿的机械通气率、血液净化率、多器官功能障碍发生率以及急性肾衰竭发生率升高。AKI衰竭期（3期）患儿的院内病死率明显高于风险期（1期）、损伤期（2期）患儿，但是这种差异在平均住院天数、治愈率方面无明显体现。综合考虑，与RIFLE分级标准相比，建议儿童采用AKIN标准进行AKI诊断及分期更具临床可行性。
[Abstract]:Objective: To explore the diagnostic significance of RIFLE and AKIN in children with AKI in order to be helpful to the early diagnosis and early intervention treatment of clinical AKI. Methods: The medical records of 1328 hospitalized children with primary, secondary renal disease and abnormal renal function were analyzed retrospectively from January 1, 2011 to December 31, 2011, affiliated Children's Hospital of Chongqing Medical University. The clinical features, laboratory indexes, treatment and prognosis of children with AKI diagnostic criteria were screened. The data were analyzed by SPSS17.0 software, and the diagnostic significance of RIFLE and AKIN criteria in children with AKI was discussed. Results: 1. Of the 1328 hospitalized children, 223 were in accordance with AKI diagnostic criteria. Among them, 222 cases met the standard of RIFLE stratification, and 223 cases met the standard of AKIN staging. 89 cases (39. 9%) reached the standard of ARF. Of the 2.223 children with AKI, 2.223 were male (67.7%) and 72 female (32.3%) with the maximum age of 16 years 2 months and the minimum age of 1 hour 3 minutes, with a median age of 3 months in September. In the distribution of prognosis, 88 cases were cured (39.5%), 80 cases improved (35.9%), 40 cases (17.9%) were not cured, and 15 cases died (6.7m). 3. According to the stratified diagnostic criteria of RIFLE, 46 patients with AKI risk period were involved in the risk period, 72 patients in the injury stage and 46.8 patients in the failure stage. 4. The AKIN standard was adopted in 45 cases of stage 1 of AKI 1 and 59 cases of stage 2 of AK I 2, including 59 cases of stage 2 and 119 cases of stage 3. 5. Compared with the RIFLE criterion, there was no significant advantage in the diagnosis of AKI in children (蠂 ~ 2 ~ 2 ~ (-1) / P ~ (0.962). 6. In staging diagnosis, there was no significant difference in risk period, injury stage and failure stage between stage 1 and stage 2 of AKIN and RIFLE standard (P 0.05). 7. The prognostic distribution, mechanical ventilation rate, blood purification rate, the incidence of multiple organ dysfunction and the incidence of acute renal failure were significantly different in different AKI stages, regardless of using RIFLE or AKIN criteria. 8. With the aggravation of the severity of AKI (that is, by stages, the nosocomial mortality increased. AKI failure stage 3), the nosocomial mortality was significantly higher than that in the risk period (stage 1), the injury stage (stage 2), while the risk period of AKI and the stage of injury (or stage 1 and stage 1) were significantly higher than those in the risk period (stage 1 and stage 1). Stage 2) the difference of hospital mortality was not statistically significant. In addition, the cure rate of AKI in different stages had no significant difference in average hospitalization days. Conclusion: There was no significant difference between RIFLE stratified diagnostic criteria and AKIN criteria in the diagnosis of children with AKI. There was no significant difference in the distribution of short-term prognosis between stage 1 and stage 2 and stage 3 of AKI diagnosed by AKIN criterion and RIFLE standard, injury stage and failure stage. The short-term prognosis of children with AKI staging according to two different diagnostic criteria cannot be considered to be different. However, whether according to RIFLE criteria or AKIN criteria for staging diagnosis, the distribution of short-term prognosis in children with different grades of AKI was significantly different. The severity of AKI (i.e., the exacerbation of AKI staging) was closely related to the short term poor prognosis of the children. With the exacerbation of the severity of AKI, the rate of mechanical ventilation, blood purification, The nosocomial mortality of children with multiple organ dysfunction and acute renal failure was significantly higher than that of children at risk stage 1 and injury stage 2, but the average length of hospitalization was higher than that of children with acute renal failure. The cure rate is not obvious. In general, compared with RIFLE grading standard, it is more feasible for children to use AKIN criteria for AKI diagnosis and staging.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R726.9

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