本文選題：急性腎損傷 + 兒童�。� 參考：《重慶醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的： 探討RIFLE和AKIN兩種分級診斷標(biāo)準(zhǔn)在兒童AKI中的診斷意義，以期對臨床AKI患兒的早期診斷、早期干預(yù)治療有所助益。 方法： 回顧性分析重慶醫(yī)科大學(xué)附屬兒童醫(yī)院2011年1月1日--2011年12月31日收住入院的診斷原發(fā)性、繼發(fā)性腎臟疾病以及腎功能異常的1328例住院患兒的病歷資料，篩檢出符合AKI診斷標(biāo)準(zhǔn)患兒的臨床特征、實(shí)驗(yàn)室指標(biāo)、治療及病情轉(zhuǎn)歸等情況，采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理分析，探討RIFLE和AKIN標(biāo)準(zhǔn)兩種分級診斷標(biāo)準(zhǔn)在兒童AKI中的診斷意義。 結(jié)果： 1.在回顧性分析的1328例住院患兒中，符合AKI診斷標(biāo)準(zhǔn)的223例。其中，符合RIFLE分層標(biāo)準(zhǔn)的222例，，達(dá)到AKIN分期標(biāo)準(zhǔn)的223例，89例（39.9%）患兒達(dá)到ARF標(biāo)準(zhǔn)。 2.223例AKI患兒中，男151例（67.7%），女72例（32.3%）；最大年齡為16歲2月，最小年齡為1小時(shí)3分，中位年齡為3歲9月。預(yù)后分布中，治愈88例（39.5%），好轉(zhuǎn)80例（35.9%），未愈40例（17.9%），死亡15例（6.7%）。 3.根據(jù)RIFLE分層診斷標(biāo)準(zhǔn)，AKI風(fēng)險(xiǎn)期46例（20.7%），損傷期72例（32.4%），衰竭期104例（46.8%）。 4.采用AKIN標(biāo)準(zhǔn)，AKI1期45例（20.2%），2期59例（26.4%），3期119例（53.4%）。 5.與RIFLE標(biāo)準(zhǔn)相比較，AKIN標(biāo)準(zhǔn)在兒童AKI的診斷方面沒有明顯優(yōu)勢（χ~2=1，P=0.962）。 6.分期診斷方面，AKIN標(biāo)準(zhǔn)1期、2期、3期與RIFLE標(biāo)準(zhǔn)對應(yīng)的風(fēng)險(xiǎn)期、損傷期、衰竭期無明顯統(tǒng)計(jì)學(xué)差異（P0.05）。 7.無論采用RIFLE標(biāo)準(zhǔn)或AKIN標(biāo)準(zhǔn)，不同AKI分期的預(yù)后分布、機(jī)械通氣率、血液凈化率、多器官功能障礙發(fā)生率以及急性腎衰竭發(fā)生率均有統(tǒng)計(jì)學(xué)差異。 8．隨著AKI嚴(yán)重程度的加重（即分期的加重），院內(nèi)病死率升高。AKI衰竭期（3期）患兒的院內(nèi)病死率明顯高于風(fēng)險(xiǎn)期（1期）、損傷期（2期），而AKI風(fēng)險(xiǎn)期與損傷期（或1期與2期）患兒的院內(nèi)病死率差異未達(dá)到統(tǒng)計(jì)學(xué)意義。此外，AKI不同分期的治愈率、平均住院天數(shù)的無明顯統(tǒng)計(jì)學(xué)差異。 結(jié)論： RIFLE分層診斷標(biāo)準(zhǔn)和AKIN標(biāo)準(zhǔn)在兒童AKI的診斷方面沒有明顯差別。AKIN標(biāo)準(zhǔn)診斷的1期、2期、3期與RIFLE標(biāo)準(zhǔn)對應(yīng)的風(fēng)險(xiǎn)期、損傷期、衰竭期的近期預(yù)后分布無統(tǒng)計(jì)學(xué)差異，尚不能認(rèn)為根據(jù)兩個(gè)不同診斷標(biāo)準(zhǔn)進(jìn)行分期的AKI患兒近期預(yù)后有差別。但是，無論是按照RIFLE標(biāo)準(zhǔn)還是AKIN標(biāo)準(zhǔn)進(jìn)行分期診斷，不同分級AKI患兒的近期預(yù)后分布有明顯差異，AKI嚴(yán)重程度的加重（即AKI分期的加重）與患兒的近期不良預(yù)后密切相關(guān)。隨著AKI嚴(yán)重程度的加重（分期的加重），AKI患兒的機(jī)械通氣率、血液凈化率、多器官功能障礙發(fā)生率以及急性腎衰竭發(fā)生率升高。AKI衰竭期（3期）患兒的院內(nèi)病死率明顯高于風(fēng)險(xiǎn)期（1期）、損傷期（2期）患兒，但是這種差異在平均住院天數(shù)、治愈率方面無明顯體現(xiàn)。綜合考慮，與RIFLE分級標(biāo)準(zhǔn)相比，建議兒童采用AKIN標(biāo)準(zhǔn)進(jìn)行AKI診斷及分期更具臨床可行性。
[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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R726.9

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