rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2018-3-36-45rmt-1689Research ArticleУЛУЧШЕНИЕ РАБОТЫ ОРИТOPTIMIZATION OF ICUОценка качества оказания медицинской помощи пациентам с риском развития острого почечного поврежденияEvaluation of Quality of Medical Care to Patients with the Risk of Developing Acute Kidney InjuryДацА. В.DatsA. V.avdats@rambler.ruДацЛ. С.DatsL. S.Иркутская государственная медицинская академия последипломного образования — филиал Российской медицинской академии непрерывного профессионального образования Минздрава РФРоссияIrkutsk State Medical Academy of Postgraduate education, Russian Medical Academy of Continuing professional education, Ministry of Health of RussiaRussian Federation2018020720181433645Copyright © Дац А.В., Дац Л.С., 20182018Дац А.В., Дац Л.С.Dats A.V., Dats L.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1689

Цель работы — проведение анализа качества оказания медицинской помощи пациентам с риском развития острого почечного повреждения.

Материалы и методы

Материалы и методы. Работа основана на ретроспективном анализе 140 историй болезни пациентов, у которых острое почечное повреждение развилось за время пребывания в отделениях реанимации и интенсивной терапии, хирургических и терапевтических отделениях районных больниц Иркутской области с2012 г. по2017 г. Истории болезни предоставлены Территориальным фондом обязательного медицинского страхования граждан Иркутской области. В исследование включены только те истории болезни, с результатами экспертизы которых согласились представители администрации больницы.

Результаты

Результаты. Неадекватная оценка риска развития острого почечного повреждения выявлена у 61% пациентов. Наиболее распространенными неадекватно оцененными повреждающими факторами были критические состояния — 36% (50/140), сепсис — 27% (38/140) и нефротоксические препараты — 19% (26/140). Среди неадекватно оцененных предрасполагающих факторов, на которые можно влиять, наиболее распространены хронические заболевания сердца — 42% (59/140), дегидратация/гиповолемия — 34% (47/140), хроническая болезнь почек — 29% (41/140) и анемия 25% (35/140). У пациентов с риском развития острого почечного повреждения неадекватное обследование и неадекватное проведение поддерживающей терапии выявлено в 66 и 56%, соответственно. При анализе проведения поддерживающей терапии при риске острого почечного повреждения выделены основные недостатки: не обеспечены волемический объем и перфузионное давление в 45% (63/140) случаев и не прекращено действие нефротоксических и не показанных препаратов в 31% (44/140) случаев.

Заключение

Заключение. Медицинскую помощь хорошего качества получили 24% пациентов с риском острого почечного повреждения, которое развилось в ОРИТ, хирургических и терапевтических отделениях районных больниц Иркутской области. В 14% случаев развитие острого почечного повреждения при воздействии нефротоксических препаратов, дегидратации/гиповолемии было предсказуемо и предотвратимо. 

The purpose of the research: to analyze the quality of medical care of patients who are at risk of developing acute kidney injury.

Materials and methods

Materials and methods. The work is based on a retrospective analysis of medical records of 140 patients with an acute kidney injury developed during their stay the intensive care units, surgical and medical units of district hospitals the Irkutsk Oblast over the period from 2012 to 2017.

Results

Results. Inadequate assessment of the risk of an acute kidney injury was identified in 61% of patients. The most common inadequately assessed damaging factors were critical conditions (in 36% (50/140), sepsis (27% (38/140), and nephrotoxic drugs (19% (26/140). Among inadequately evaluated predisposing factors that could be managed, the following ones were most common: chronic heart disease (in 42% (59/140), dehydration/hypovolaemia (34% (47/140), chronic kidney disease (29% (41/140), and anemia (25% (35/140). In patients at risk of an acute kidney injury, an inadequate examination and inadequate maintenance therapy were found in 66% and 56% cases, respectively. Analysis of implementation of supporting therapy in patients at risk of an acute kidney injury the following misconducting events were revealed: (i) no optimal volumic and perfusion support (59% (82/140) and (ii) no cancellation of nephrotoxic and improperly prescribed drugs (31% (44/140).

Conclusions

Conclusions. A good quality medical care restricted only by 24% of patients at risk of an acute kidney injury developed in the ICU, surgical and medical departments of district hospitals of the Irkutsk Oblast. The development of an acute kidney injury when exposed to nephrotoxic drugs and dehydration/ hypovolemia in 14% of cases was predictable and preventable. 

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The authors declare that there are no conflicts of interest present.