Kev mob raum mob hnyav: tshwm sim, Aetiology, Kev Tswj Xyuas thiab Cov txiaj ntsig ntsuas ntawm Samoan Case Series

TSAB NTAWV

Keeb kwm:Mob raum mob(AKI) yog qhov tseem ceeb thiab tsis lees paub qhov ua rau muaj mob thiab tuag thoob ntiaj teb. Cov teb chaws tau nyiaj tsawg thiab nruab nrab tau txais lub nra hnyav tshaj plaws ntawm AKI (85%). Tam sim no tsis muaj cov ntaub ntawv luam tawm rauAKIlos ntawm Pacific Islands. Txoj kev tshawb fawb tam sim no tsom los qhia txog qhov xwm txheej, etiology, kev tswj hwm, thiab cov txiaj ntsig kev ntsuas ntawm AKI los ntawm lub tsev kho mob tertiary referral ntawm Samoa. Cov ntaub ntawv thiab txoj kev:Ib-centre prospective soj ntsuam kev kawm. Participants were recruited by the lead investigator from the hospital patient information system. The inclusion criteria for participation was (1) adults (>18 xyoo) tau mus rau hauv pawg ntseeg dav dav ntawm Tupua Tamasee Meaole (TTM) Tsev Kho Mob nrog kuaj mob AKI thaum lub Kaum Ob Hlis 1, 2019, thiab Lub Tsib Hlis 31, 2020, thiab (2)qib creatinine hauv cov ntshavof >200 μmol / L, thiab (3) ua raws li tam sim noKab mob raumTxhim kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) cov qauv rau kev kuaj mob AKI. Daim ntawv sau cov ntaub ntawv tau raug hloov kho los ntawm International Society for Nephrology - Ntiaj Teb Snapshot Project thiab tau sau tseg cov pej xeem thiab cov yam ntxwv hauv paus, ua rau muaj nag lossis daus ntawm AKI, kev kho mob / kev tswj hwm, thiab kev ntsuas cov txiaj ntsig.

YUAV UA LI CAS RAU CISTANCHE ua haujlwm rau cov neeg mob rau lub raum?

Cov txiaj ntsig:Muaj tag nrho ntawm 114 AKI kev txais neeg kawm nyob rau lub sijhawm kawm sib raug rau hauv tsev kho mob AKI qhov tshwm sim ntawm 26.8 rau 1000 kev nkag mus rau 6 lub hlis. 75% ntawm AKI kis tau los ntawm zej zog. Qhov ua rau AKI yog lub cev qhuav dej (79%) thiab sepsis (64%). Ntau tshaj 40% ntawm cov neeg mob uas muaj ob lossis ntau dua Cov Kab Mob Tsis Muaj Kab Mob sib kis. Tus neeg mob tuag tus nqi yog 20.2%. Hauv 3 lub hlis tom qab tso tawm hauv tsev kho mob, 25% ntawm cov neeg mob AKI tau daws tag nrho, 25% ntawm cov neeg mob tau tuag, thiab 18.7% ntawm cov neeg mob AKI tau nce mus rau mob raum. Qhov ua rau neeg tuag yogkab mob plawv(35%) thiab sepsis (35%). Cov ntsiab lus: Cov xwm txheej hauv tsev kho mob thiab cov txiaj ntsig tsis zoo ntawm AKI yog siab hauv Samoa. Kev paub ntau dua ntawm qhov tsis pom zoo no tau lees paub ntawm cov pej xeem, tsoomfwv, thiab cov kws tshaj lij kev noj qab haus huv.

1. Taw qhia

Mob raum mob(AKI) tau piav raws li kev nce nrawm hauvntshav creatinine, txo cov zis tso zis, los yog ob qho tib si [1]. AKI tsis yog ib qho kab mob hauv nws tus kheej, tab sis nws yog qhov ntsiag to thiab tsis paub txog tus mob uas muaj nyob rau ntawm ib qho spectrum, feem ntau yog theem nrab rau lwm yam aetiologies loj xws liplawv tsis ua hauj lwmthiab sepsis/shock [1]. AKI muaj feem xyuam nrog ntau yam txheej txheem pathophysiological uas suav nrog kev khaws cov khoom pov tseg, tsis muaj electrolyte homeostasis, thiab cov lus teb dav dav cuam tshuam rau cov kabmob nyob deb [2]. Nws sawv cev rau 10-15% ntawm kev mus pw hauv tsev kho mob thoob ntiaj teb, thiab AKI feem ntau hauv chav kho mob hnyav tuaj yeem tshaj 50% [1]. Kev lees paub ntxov ntawm AKI ua rau kev tswj xyuas raws sijhawm thiab kev txhim kho / rov ua haujlwm ntawm lub raum thiab yog li txo qhov kev pheej hmoo ntawm kev mob mus sij hawm ntev thiab kev tuag los ntawm ob lub raum kab mob thiab thawj qhov kev txhawj xeeb txog kev noj qab haus huv (piv txwv li, myocardial infarct) [1, 2].

Kev pom zoo thoob ntiaj teb tam sim no hais txog lub ntsiab lus ntawm AKI yog thaum, nyob rau lub sijhawm ntawm xya hnub lossis tsawg dua, tus neeg mob nthuav tawm nrog ntau dua lossis sib npaug li 1.5 npaug ntawm qhov nce hauv cov ntshav creatinine (lossis nce ntau dua lossis sib npaug rau {{2. }}.3 mg/dL nyob rau hauv ib lub sij hawm 48h), thiab/los yog zis ntim =< 0.5 ml/kg for more than 6 h. The definition of AKI is further classified into three stages of increasing severity (Table 1). These criteria were published by the Kidney Disease Improving Global Outcomes (KDIGO) group to serve as an international gold standard, as well as to facilitate unity and comparison between AKI research findings worldwide. 

Raws li kev tshawb fawb thoob ntiaj teb kev kis kabmob [2–4], lub nra hnyav tshaj plaws ntawm AKI (85%) yog pom hauvcov nyiaj tau los tsawgthiab cov teb chaws tau nyiaj tsawg nruab nrab (LLMICs). Qhov tshwm sim siab ntawm AKI hauv cov tebchaws no feem ntau yog vim muaj ib puag ncig ib puag ncig, tshwj xeeb rau cov dej tsis huv thiab kab mob sib kis (xws li, malaria nyob rau sab av loj African) [2]. Kuj tseem muaj pov thawj tias AKI cuam tshuam rau cov neeg hluas hauv cov chaw tsis muaj peev xwm, nrog rau lub raum tsis ua haujlwm, muaj teeb meem hauv tsev menyuam, kis kab mob, thiab co toxins uas ua rau lub raum raug mob [5]. Thaum qhov kev faib ua feem ntau ntawm AKI tshawb fawb (82.7%) yog tsim los ntawm cov teb chaws tau nyiaj tau los, ob peb txoj kev tshawb fawb los ntawm cov chaw muaj peev txheej qis qhia tau hais tias feem ntau ntawm AKI tiv thaiv tau. Txog rau qhov kawg no, International Society of Nephrology tau pib lub "0by25 Initiative", uas yog lub hom phiaj txhawm rau tshem tawm AKI tiv thaiv tau ua rau muaj kev tuag thoob ntiaj teb [6,7]. Kev tshuaj xyuas cov ntaub ntawv pom tias tam sim no tsis muaj kev tshaj tawm ntawm AKI hauv Pacific Islands.

Samoa yog ib lub tebchaws Polynesian ntawm thaj av Pacific Island (Daim duab 1). Tupua Tamasese Meaole (TTM) Tsev Kho Mob yog tib lub chaw xa mus rau theem siab hauv lub tebchaws, thiab nws nyob hauv lub nroog Apia. Kev tshuaj xyuas cov ntaub ntawv ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kub Ntxhov Kub Kub thiab Cov Tshuaj Hauv Tsev tau qhia tias AKI yuav yog qhov tseem ceeb tseem tsis tau lees paub txog kev nthuav qhia rau TTM lub tsev kho mob. Muab cov ntaub ntawv tshaj tawm txog lub raum tsis ua haujlwm thiab hemodialysis hauv Samoa [8,9], lub hom phiaj ntawm txoj kev tshawb fawb tam sim no yog los ntsuas qhov tshwm sim, etiology, kev tswj hwm, thiab cov txiaj ntsig kev ntsuas ntawm cov neeg laus hauv tsev kho mob TTM nrog kev kuaj mob AKI. Cov txiaj ntsig ntawm txoj kev tshawb no yuav tsum tsis tsuas yog txhim kho kev txheeb xyuas ntxov thiab kev tswj hwm ntawm AKI hauv peb qhov chaw, nws kuj tseem tuaj yeem ua rau txo lub nra ntawm cov kab mob raum rau peb lub teb chaws.

2. Cov txheej txheem

2.1. Kev pom zoo rau kev ncaj ncees

Kev pom zoo rau kev ncaj ncees rau txoj kev tshawb fawb tam sim no tau txais los ntawm Fiji National University College Health Research Ethics Committee (CHREC) thiab tsoom fwv ntawm Samoa Ministry of Health - Health Research Committee (MoH-HRC). Gatekeeper kev pom zoo kuj tau txais los ntawm Tus Lwm Thawj Coj Thawj Coj ntawm TTM Tsev Kho Mob.

2.2. Kev sau npe

Raws li tsab ntawv tshaj tawm ntawm Helsinki tias "Txhua txoj kev tshawb fawb txog tib neeg cov kev kawm yuav tsum tau sau npe rau hauv cov ntaub ntawv tuaj yeem siv tau rau pej xeem", txoj kev tshawb no tau sau npe nrog ClinicalTrials.gov (Protocol ID: 117.19; ClinicalTrials.gov ID: NCT05167292).

Table 1 KDIGO txhais ntawm AKI.