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目的:分析基层医院急性肾衰竭(ARF)的病因,寻找影响其预后的危险因素,为降低ARF发病率,提高临床疗效,判断预后提供参考。方法:以2007年6月～2009年6月就诊于温岭市第一人民医院等4个基层医院的ARF患者为研究对象,归纳引起ARF的病因;将其分为治愈组、好转组、无效组和死亡组,首先采用单因素分析方法初步筛查出危险因素,然后将初筛的危险因素进一步使用二分类Logistic回归法做多因素分析,判别各因素对死亡危险度的影响。结果:(1)301224例住院患者中,ARF患者568例(占0.19%);其中男366例(占64.45%),女202例(占35.56%),男女之比1.8∶1。(2)568例ARF患者中,按照肾性、肾前性和肾后性分类方法,以肾性ARF最常见,共282例(占49.65%),肾前性ARF140例(占24.65%),肾后性ARF146例(占25.70%)。按照引起ARF的原因分类,肾实质损害和梗阻所占比例最大,分别为22.89%和21.65%,其次是感染和药物因素,分别占11.97%和9.15%。(3)多脏器功能衰竭(MODS)、高血钾及贫血是导致ARF预后差的危险因素。结论:ARF发病率为0.19%,男性多于女性,除肾原性原因外,肾后梗阻、感染和药物性肾损害是最常见原因。MODS、贫血、高血钾是影响预后的危险因素。
Objective: To analyze the etiopathogenisis of acute renal failure (ARF) in primary hospitals and to find out the risk factors that affect its prognosis, so as to provide a reference for reducing the incidence of ARF, improving the clinical curative effect and judging prognosis. Methods: ARF patients from 4 primary hospitals, including Wenling First People’s Hospital, from June 2007 to June 2009 were enrolled in this study. The causes of ARF were summarized. The patients were divided into three groups: the curative group, the remission group, the ineffective group And death group, the first screening of risk factors by univariate analysis, and then further screening of risk factors using the binary Logistic regression analysis of multivariate analysis to determine the impact of various factors on the risk of death. Results: (1) Of the 312,224 hospitalized patients, ARF patients were 568 (0.19%), of whom 366 (64.45%) were male and 202 (35.56%) were women, the ratio of men to women was 1.8: 1. (2) Among 568 cases of ARF, ARF was the most common in renal, prerenal and posterior renal categories, with 282 cases (49.65%) and 40 cases of prerenal ARF (24.65%), Renal ARF146 cases (accounting for 25.70%). According to the cause of ARF classification, the largest proportion of renal parenchymal damage and obstruction, respectively, 22.89% and 21.65%, followed by infection and drug factors, accounting for 11.97% and 9.15%. (3) Multiple organ failure (MODS), hyperkalemia and anemia are the risk factors for the poor prognosis of ARF. CONCLUSION: The incidence of ARF is 0.19%, more men than women. In addition to renal causes, renal obstruction, infection and drug-induced renal damage are the most common causes. MODS, anemia, hyperkalemia are risk factors affecting the prognosis.