诊断学理论与实践

诊断学理论与实践 ›› 2017, Vol. 16 ›› Issue (06): 596-600.doi: 10.16150/j.1671-2870.2017.06.007

• 论著 • 上一篇    下一篇

院内实时监控系统显著提高住院急性肾损伤患者识别率

王一梅, 滕杰, 沈波, 许佳瑞, 姜物华, 於佳炜, 胡家昌, 丁小强   

  1. 复旦大学附属中山医院肾内科 上海市肾病与透析研究所 上海市肾脏疾病临床医学中心上海市肾脏疾病与血液净化重点实验室,上海 200032
  • 收稿日期:2017-09-11 出版日期:2017-12-25 发布日期:2017-12-25
  • 通讯作者: 丁小强 E-mail: ding.xiaoqiang@zs-hospital.sh.cn
  • 基金资助:
    上海市科学技术委员会科研项目（17140902300）; 复旦大学附属中山医院管理基金（2016ZSGL01）

Real-time electronic alert system improving the detection of acute kidney injury

WANG Yimei, TENG Jie, SHEN Bo, XU Jiarui, JIANG Wuhua, YU Jiawei, HU Jiachang, DING Xiaoqiang   

  1. Department of Nephrology, Zhongshan Hospital, Fudan University; Shanghai Institute of Kidney and Dialysis; Shanghai Medical Center of Kidney Disease; Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai 200032, China
  • Received:2017-09-11 Online:2017-12-25 Published:2017-12-25

PDF (PC)

88

摘要： 目的: 建立院内急性肾损伤（acute kidney injury, AKI）电子实时监控系统(electronic alerts, E-Alerts),观察该系统诊断住院患者发生AKI的价值,并与人工诊断结果进行比较。方法: 选取2014年11月3日至9日于复旦大学附属中山医院住院的2 563例成年患者（≥18岁）,采用E-Alerts检出AKI患者261例,并与人工诊断结果（92例）进行比较。结果: 应用E-Alerts后,AKI检出率为10.20%,而人工识别率为3.59%（P=0.03）。261例发生AKI的患者中,男性176例,女性85例,平均年龄为（63±16）岁, 1期、2期、3期和接受肾脏替代治疗患者的AKI检出率分别为8.4%（216/2 563）、0.5%(12/2 563)、1.3%(33/2 563)和0.7%(17/2 563),而AKI患者院内病死率为5.7%（15/261）。AKI患者中244例（93.5%）来自非肾内科,而仅有24例（9.8%）邀请肾内科医师会诊,出院诊断包含AKI相关诊断者仅4例（1.5%）。AKI发生率高的科室分别为心外科（39.0%）、肾内科（33.0%）和肝肿瘤外科（19.0%）。68例（26.1%）患者为社区获得性AKI,193例（73.9%）医院获得性AKI患者。AKI患者的住院天数、住院费用及病死率均显著高于非AKI患者（P<0.05）。多因素logistic回归显示,AKI分期（OR=3.479,95%CI 为1.890~6.406,P=0.001)和年龄（OR=1.067,95%CI 为1.021~1.113,P=0.003）是AKI患者死亡的独立危险因素。结论: 发生AKI的患者绝大多数来自非肾内科,出院诊断漏诊严重[98.5%（257/261）],肾内科会诊率低。院内AKI监控网络的建立可显著提高AKI患者的识别率,提高广大医师对AKI的认识,及时开展干预措施,改善患者预后。

关键词: 急性肾损伤, 检出率, 实时网络监控, 人工统计

Abstract: Objective: To investigate the occurrence of acute kidney injury（AKI）in hospitalized patients, and to compare the detection rate by real-time electronic alert system with the results by manual diagnosis. Methods: A total of 2 563 hospitalized patients in Zhongshan Hospital, Fudan University from November 3rd, 2014 to November 9th, 2014 were screened by real-time electronic alert system and the results of manual diagnosis were compared. Results: Detection rates by electronic alert system and manual diagnosis were 10.2% and 3.59%, respectively. The median age of AKI patients was (63±16) years, and among them 176 cases (67.4%) were male and 17 cases（6.5%） received renal replacement therapy; the hospital mortality of AKI patients was 5.7%. Of them 93.5% of patients were not from Department of Nephrology, and only 9.8% received consultation by nephrologists. Only 1.5% had discharge diagnosis of AKI related to acute kidney injury. The Departments with the high incidence of AKI were Cardiac Surgery(39.0%), nephrology(33.0%) and Liver Surgery (19.0%). The incidence of community acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) were 26.1% and 73.9%, respectively. The AKI group had significantly longer hospital stay and higher expenses than the non-AKI group (P<0.05). Of AKI patients, AKI stage(KDIGO criteria) and age were independent risk factors of in-hospital mortality according to the results of multivariate logistic regression. Conclusions: The majority of AKI patients are not from Department of Nephrology and has high missed diagnosis rate and low consultation rate by nephrologists. The establishment of AKI electronic alerting system can significantly increase the recognition rate of AKI patients, raise doctors’ awareness of AKI, and may help to improve the prognosis of AKI patients.

Key words: Acute kidney injury, Incidence, Electronic alert system, Manual statistics

中图分类号: