CN105303261A - Nosocomial acute kidney injury early warning system - Google Patents
Nosocomial acute kidney injury early warning system Download PDFInfo
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- CN105303261A CN105303261A CN201510764768.0A CN201510764768A CN105303261A CN 105303261 A CN105303261 A CN 105303261A CN 201510764768 A CN201510764768 A CN 201510764768A CN 105303261 A CN105303261 A CN 105303261A
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Abstract
The invention discloses a nosocomial acute kidney injury early warning system, and relates to the field of medical instruments. The system comprises a detection device which is used for detecting a serum creatinine value with the previously detected serum creatinine values acting as serum creatinine underlying values, and the serum creatinine values detected within the latter seven days acting as serum creatinine detection values; a calculation device which is used for determining rising times of serum creatinine according to the serum creatinine underlying values and the serum creatinine detection values; an early warning level determining device which is used for determining the early warning level of acute kidney injury according to the rising times of serum creatinine; and an alarm device which is used for transmitting early warning information to corresponding workstations according to the determined early warning level of acute kidney injury. Early warning of the critical value of serum creatinine of patients is performed so that medical personnel can be assisted to change the current situation that current clinical disease course diagnosis is not timely and intervene is not timely.
Description
Technical field
The present invention relates to medical instruments field, particularly acute injury of kidney early warning system in hospital.
Background technology
Acute injury of kidney is one group of clinical syndrome, and refer to the decreased renal function of acute and lasting (being greater than 24 hours) in short-term (1-7 days), clinical case fatality rate is very high.Show according to multicenter investigation result, China had 2,900,000 adult acute injury of kidney inpatients at least in 2013,78.7% is wherein had not obtain timely Clinics and Practices, therefore clinical leaky bucket model phenomenon is very serious, improves and improve clinical detection rate and diagnosis and treatment opportunitys of acute injury of kidney in the urgent need to effective measures.
Summary of the invention
The object of the present invention is to provide acute injury of kidney early warning system in a kind of hospital, achieved a kind of system can carrying out early warning to patients acuity injury of kidney, thus reduce clinical leaky bucket model rate.
According to an aspect of the present invention, provide acute injury of kidney early warning system in hospital, comprising:
Pick-up unit, for detecting serum creatinine value, and using the serum creatinine value that obtains in front detection as serum creatinine basic value, will detect the serum creatinine value that obtains as serum creatinine detected value in latter seven days;
Calculation element, for according to described serum creatinine basic value and described serum creatinine detected value, determines that serum creatinine raises multiple;
Advanced warning grade determining device, for raising multiple according to described serum creatinine, determines acute injury of kidney advanced warning grade;
Warning device, for according to determined acute injury of kidney advanced warning grade, is sent to corresponding workstation by early warning information.
Preferably, described calculation element, by described serum creatinine detected value and described serum creatinine basic value being divided by, obtaining serum creatinine and raises multiple.
Preferably, described calculation element also for described serum creatinine detected value and described serum creatinine basic value being subtracted each other, obtains serum creatinine elevation amplitude.
Preferably, described serum creatinine is raised multiple and compares with default first multiple threshold value, default second multiple threshold value and default triple threshold value respectively by described advanced warning grade determining device, and according to comparative result, determines acute injury of kidney advanced warning grade.
Preferably, be more than or equal to default first multiple threshold value if described serum creatinine raises multiple and be less than default second multiple threshold value, then described advanced warning grade determining device determination acute injury of kidney advanced warning grade is one-level.
Preferably, described advanced warning grade determining device is also more than or equal to default serum creatinine elevation amplitude threshold value for the serum creatinine elevation amplitude in two days, and described serum creatinine raises multiple when being less than default second multiple threshold value, determines that acute injury of kidney advanced warning grade is one-level.
Preferably, be more than or equal to default second multiple threshold value if described serum creatinine raises multiple and be less than default triple threshold value, then described advanced warning grade determining device determination acute injury of kidney advanced warning grade is secondary.
Preferably, if described serum creatinine raises multiple be more than or equal to default triple threshold value, then described advanced warning grade determining device determination acute injury of kidney advanced warning grade is three grades.
Preferably, described advanced warning grade determining device, also for described serum creatinine detected value and default serum creatinine threshold value being compared, if described serum creatinine detected value is more than or equal to default serum creatinine threshold value, then determines that acute injury of kidney advanced warning grade is three grades.
Preferably, described advanced warning grade determining device is also less than default serum creatinine elevation amplitude threshold value for the serum creatinine elevation amplitude in two days, and serum creatinine in seven days raises multiple when being less than default first multiple threshold value, determines that current needs carries out acute injury of kidney early warning.
Compared with prior art, beneficial effect of the present invention is:
The present invention carries out early warning by serum creatinine detected value to the acute injury of kidney of patient, realizes acute injury of kidney robotization early warning system in hospital, contributes to the treatment level significantly improving the disease initial period.
Accompanying drawing explanation
Fig. 1 is acute injury of kidney early warning system block diagram in the hospital that provides of first embodiment of the invention;
Fig. 2 is the workflow diagram of acute injury of kidney early warning system in the hospital that provides of first embodiment of the invention;
Fig. 3 is acute injury of kidney early warning system block diagram in the hospital that provides of second embodiment of the invention;
Fig. 4 is the workflow diagram of acute injury of kidney early warning system in the hospital that provides of second embodiment of the invention;
Fig. 5 is the fundamental diagram of acute injury of kidney early warning system in the hospital that provides of third embodiment of the invention.
Embodiment
Below in conjunction with accompanying drawing to a preferred embodiment of the present invention will be described in detail, should be appreciated that following illustrated preferred embodiment is only for instruction and explanation of the present invention, is not intended to limit the present invention.
Fig. 1 is acute injury of kidney early warning system block diagram in the hospital that provides of first embodiment of the invention, and as shown in Figure 1, system comprises pick-up unit 10, calculation element 20, advanced warning grade determining device 30 and warning device 40.
Pick-up unit 10, for detecting serum creatinine value, and using the serum creatinine value that obtains in front detection as serum creatinine basic value, using detecting the serum creatinine value that obtains as serum creatinine detected value in latter seven days, inputs to calculation element 20 respectively.This pick-up unit 10 can be existing detecting instrument, to be tested analysis, obtain serum creatinine value by detecting instrument to the blood sample of patient extracted.
Calculation element 20 is for according to serum creatinine basic value and serum creatinine detected value, determine that serum creatinine raises multiple, in the present embodiment, use serum creatinine detected value divided by serum creatinine basic value, obtain serum creatinine and raise multiple, further, use serum creatinine detected value to deduct serum creatinine basic value, obtain serum creatinine elevation amplitude.
Advanced warning grade determining device 30, for raising multiple according to serum creatinine, determines acute injury of kidney advanced warning grade.Specifically, when determining whether early warning and advanced warning grade, generally compare with default first multiple threshold value, default second multiple threshold value and default triple threshold value respectively by serum creatinine being raised multiple, and according to comparative result determination acute injury of kidney advanced warning grade.
One, in seven days, when serum creatinine rising multiple is more than or equal to default first multiple threshold value and is less than default second multiple threshold value, determine that acute injury of kidney advanced warning grade is one-level; When serum creatinine rising multiple is more than or equal to default second multiple threshold value and is less than default triple threshold value, determine that acute injury of kidney advanced warning grade is secondary; When serum creatinine rising multiple is more than or equal to default triple threshold value, determine that acute injury of kidney advanced warning grade is three grades.
Two, in two days, serum creatinine elevation amplitude is more than or equal to default serum creatinine elevation amplitude threshold value, determines that current needs carries out acute injury of kidney early warning; When serum creatinine rising multiple is less than default second multiple threshold value, determine that acute injury of kidney advanced warning grade is one-level; When serum creatinine rising multiple is more than or equal to default second multiple threshold value and is less than default triple threshold value, determine that acute injury of kidney advanced warning grade is secondary; When serum creatinine rising multiple is more than or equal to default triple threshold value, determine that acute injury of kidney advanced warning grade is three grades.
In addition, advanced warning grade determining device 30 also comprises following two kinds of situations when determining advanced warning grade:
Three, serum creatinine detected value and default serum creatinine threshold value are compared, when serum creatinine detected value is more than or equal to default serum creatinine threshold value, determine that acute injury of kidney advanced warning grade is three grades.
Four, in two days serum creatinine elevation amplitude be less than default serum creatinine elevation amplitude threshold value and in seven days serum creatinine raise multiple be less than default first multiple threshold value, determine that current needs carries out acute injury of kidney early warning.
Above-mentioned first multiple threshold value of presetting can choose [1.45,1.55] interval arbitrary value, and preferably 1.50;
Above-mentioned second multiple threshold value of presetting can choose [1.95,2.05] interval arbitrary value, and preferably 2.0;
Above-mentioned triple threshold value of presetting can choose [2.95,3.05] interval arbitrary value, is preferably 3;
Above-mentioned default serum creatinine elevation amplitude threshold value 26.5 μm of ol/L;
Above-mentioned default serum creatinine threshold value can choose [350,355] interval arbitrary value, is preferably 353.6 μm of ol/L.
That is, when serum creatinine detected value is more than or equal to 353.6 μm of ol/L, advanced warning grade determining device 30 directly determines that acute injury of kidney advanced warning grade is three grades.When serum creatinine detected value is less than 353.6 μm of ol/L, if advanced warning grade determining device 30 determines that serum creatinine (SCr) raises <0.3mg/dl (26.5 μm of ol/L) in 48 hours and raises 1.5 times less than serum creatinine basic value in 7 days, then do not carry out acute injury of kidney early warning, otherwise, if advanced warning grade determining device 30 determine rising >=0.3mg/dl (26.5 μm of ol/L) in serum creatinine 48 hours and/or raise in 7 days 1.5 times of reaching serum creatinine basic value and more than, then carry out acute injury of kidney early warning.
Early warning information, for according to determined acute injury of kidney advanced warning grade, is sent to corresponding workstation by warning device 40, and described early warning information can comprise patient identity mark, serum creatinine detected value, acute injury of kidney advanced warning grade etc.
Fig. 2 is the workflow diagram of acute injury of kidney early warning system in the hospital that provides of first embodiment of the invention, and as shown in Figure 2, step comprises:
Step S101: pick-up unit detects serum creatinine value, and using the serum creatinine value that obtains in front detection as serum creatinine basic value, will detect the serum creatinine value that obtains as serum creatinine detected value in latter seven days.
Step S102: calculation element, according to described serum creatinine basic value and described serum creatinine detected value, determines that serum creatinine raises multiple.
By serum creatinine detected value and serum creatinine basic value are divided by, obtain serum creatinine and raise multiple;
By serum creatinine detected value and serum creatinine basic value being subtracted each other, obtain serum creatinine elevation amplitude.
Step S103: advanced warning grade determining device raises multiple according to described serum creatinine, determines acute injury of kidney advanced warning grade.
When serum creatinine rising multiple is more than or equal to default first multiple threshold value and is less than default second multiple threshold value, determine that acute injury of kidney advanced warning grade is one-level;
When serum creatinine rising multiple is more than or equal to default second multiple threshold value and is less than default triple threshold value, determine that acute injury of kidney advanced warning grade is secondary;
When serum creatinine rising multiple is more than or equal to default triple threshold value, determine that acute injury of kidney advanced warning grade is three grades.
In addition, if serum creatinine elevation amplitude is more than or equal to default serum creatinine elevation amplitude threshold value, now, even if serum creatinine raises multiple be less than default first multiple threshold value, also acute injury of kidney advanced warning grade is defined as one-level.
Step S104: early warning information, according to determined acute injury of kidney advanced warning grade, is sent to corresponding workstation by warning device.
Fig. 3 is acute injury of kidney early warning system block diagram in the hospital that provides of second embodiment of the invention; as shown in Figure 3; comprise: creatinine value testing result load module 21, Analysis of test results and warning module 22 and protection renal operational module 23, can be arranged on doctor workstation system.
Creatinine value testing result load module 21 inputs to Analysis of test results and warning module 22 for the assay (i.e. serum creatinine value) obtained blood sample of patient check analysis by detecting instrument.
Analysis of test results and warning module 22 realize the function of the calculation element 20 of system shown in Figure 1, advanced warning grade determining device 30 and warning device 40.It is according to the normal creatinine numerical range preset and creatinine amplitude of variation scope, the testing result of input is automatically calculated and judged, if exceed normal range, then by network, early warning information is sent to designated terminal, prompting medical worker carries out therapeutic scheme adjustment.Analysis of test results and warning module 22 comprise further, testing result display sub-module, Analysis of test results submodule and test results report submodule, and wherein, testing result display sub-module is for showing the related check data of the given patient upgraded; Analysis of test results submodule is used for, according to default normal creatinine numerical range and amplitude of variation scope, in conjunction with the dynamic serum creatinine detected value of patient, automatically carrying out analytical calculation to the creatinine value of this patient, determines whether the critical value needing report; Test results report submodule, when patient's this creatinine detected value is critical value, sends early warning information to the terminal of associated department by network, notifies that medical worker adjusts therapeutic scheme, to reach early warning object.
Protection renal operational module 23 is for after the early warning information receiving Analysis of test results and warning module 22; to by patient's comprehensive assessment of early warning; search the predisposing factor and impairment factor that can cause acute injury of kidney; comprise the use of the high-risk medicine of renal damage, ECBV, related assays index etc., and then medical worker can be instructed to carry out therapeutic scheme adjustment.
Fig. 4 is the workflow diagram of acute injury of kidney early warning system in the hospital that provides of second embodiment of the invention, and as shown in Figure 4, step comprises:
Step S201: detecting instrument to be tested analysis to blood sample of patient, obtains serum creatinine detected value a, and serum creatinine detected value creatinine value a is inputed to Analysis of test results and warning module 22 via testing result load module 21.
Step S202: Analysis of test results and warning module 22 judge whether serum creatinine detected value creatinine value a is less than default serum creatinine threshold value Ta, if a<Ta, then performs step S203, otherwise, perform step S213.
In the present embodiment, Ta=353.6 μm of ol/L.
Step S203: Analysis of test results and warning module 22 calculate serum creatinine elevation amplitude Ia and raise multiple Ib.
Elevation amplitude Ia=serum creatinine detected value a-serum creatinine basic value a0 (μm ol/L);
Raise multiple Ib=serum creatinine detected value a/ serum creatinine basic value a0.
Wherein, serum creatinine basic value a0 takes a blood sample and the serum creatinine value that obtains of check analysis to patient front, and this value needs to be saved in system in advance, in the present embodiment, also needs to preserve blood sample corresponding to serum creatinine basic value a0 in advance and extracts time t0.
Step S204: judge that blood sample corresponding to serum creatinine detected value a extracts in whether after t0 48 hours of time ta, if so, then perform step S206, otherwise, perform step S205.
Step S205: judge that blood sample corresponding to serum creatinine detected value a extracts in whether after t0 7 days of time ta, or rather, in 3 to 7 days whether after t0, if so, then performs step S207, otherwise process ends.
Step S206: judge whether elevation amplitude Ia is less than default serum creatinine elevation amplitude threshold value TIa, if Ia<TIa, then performs step S207, otherwise step S209.
In the present embodiment, TIa=26.5 μm of ol/L.
Step S207: judge whether elevation amplitude Ib is less than default first multiple threshold value TIb1, if Ib<TIb1, then performs step S208, otherwise step S209.
Step S208: Analysis of test results and warning module 22 determine that current needs carries out acute injury of kidney early warning, do not carry out early warning process.
Step S209: judge whether elevation amplitude Ib is less than default second multiple threshold value TIb2, if Ib<TIb2, then performs step S210, otherwise step S211.
This step is divided into two kinds of situations:
If the relative serum creatinine basic value a0 of 1 serum creatinine detected value a is the serum creatinine value in 48 hours, then as Ib<TIb2, perform step S210, otherwise step S211.
If the relative serum creatinine basic value a0 of 2 serum creatinine detected value a is the serum creatinine value in 3 to 7 days, then as TIb1≤Ib<TIb2, perform step S210, otherwise step S211.
Step S210: Analysis of test results and warning module 22 determine that acute injury of kidney advanced warning grade is one-level.
Step S211: judge whether elevation amplitude Ib is less than default triple threshold value TIb3, if TIb2≤Ib<TIb3, then performs step S212, otherwise step S213.
Step S212: Analysis of test results and warning module 22 determine that acute injury of kidney advanced warning grade is secondary.
Step S213: Analysis of test results and warning module 22 determine that acute injury of kidney advanced warning grade is three grades.
Above-mentioned TIb1, TIb2 and TIb3 meet TIb1<TIb2<TIb3, preferred TIb1=1.5, TIb2=2, TIb3=3.
Owing to lacking the critical value early warning of serum creatinine in prior art, therefore a lot of patient be in hospital because of acute injury of kidney does not obtain timely Clinics and Practices, occur that clinical leaky bucket model phenomenon is very serious, the present invention is based on doctor workstation system, provide acute injury of kidney early warning system in hospital, Fig. 5 is the fundamental diagram of acute injury of kidney early warning system in the hospital that provides of third embodiment of the invention, as shown in Figure 5, this system is completed by computer applied algorithm, in computer applied algorithm, default normal creatinine numerical range (44 ~ 133 μm of ol/L) and amplitude of variation scope (raise <26.5 μm of ol/L in 48 hours, and rise less than 1.5 times in 7 days), first patient's related check data (are comprised serum creatinine basic value a0 and serum creatinine detected value a) inputs computing machine, by computer applied algorithm, to patient's existing creatinine detection of dynamic information, (namely serum creatinine detected value a) carries out analytical calculation, detect the acute rising of serum creatinine in time, the amplitude of renal function change is judged, automatically early warning is carried out to acute injury of kidney.
Specifically, calculate serum creatinine amplification, comprising elevation amplitude and raise multiple, wherein, obtaining elevation amplitude by being subtracted each other by serum creatinine detected value a and serum creatinine basic value a0, obtain by serum creatinine detected value a and serum creatinine basic value a0 is divided by raising multiple.If elevation amplitude is less than 26.5 μm of ol/L in 48 hours, and raise multiple in 7 days less than 1.5 times, then do not carry out early warning process.If elevation amplitude is more than or equal to 26.5 μm of ol/L in 48 hours, and raises multiple in 7 days and be more than or equal to 1.5 times, then carry out early warning process.Generally, acute injury of kidney early warning classification is carried out according to serum creatinine elevation amplitude, serum creatinine raises and reaches 2 times below of basic value for I level, raises that to reach 2 times to being less than between 3 times be II level, raise reach be more than or equal to 3 times or serum creatinine detected value reach 353.6 μm of ol/L and above be III level.For different advanced warning grades, produce corresponding acute injury of kidney early warning report and diagnosis and treatment prompting, and be sent to associated department early warning reporting terminal, prompting supervisor medical worker, and start the training consultation of doctors, intervened in time by protection renal module.
Such as: patient's first prepares to carry out bypass surgery after being admitted to hospital, serum creatinine 88 μm of ol/L (the serum creatinine basic value as this patient) during art the previous day, in 48 hours, such as second day after operation serum creatinine is 126 μm of ol/L, relative serum creatinine basic value rises 38 μm of ol/L (126-88=38 μm of ol/L), it is greater than in 48 hours the standard of the 26.5 μm of ol/L that rise, and rises to 1.4 times (126/88=1.4 doubly) of serum creatinine basic value.Therefore, in hospital, acute injury of kidney early warning system produces the early warning of I level, and early warning information is sent to the early warning reporting terminal at heart surgical department doctor in charge workstation place, point out this patient that acute injury of kidney I level occurs, need to verify blood volume, kidney perfusion level, medicinal application, and starting tight renal monitoring, prompting attending doctor detects serum creatinine level every day.If the 3rd day monitoring serum creatinine reaches 201 μm of ol/L after this operation in patients, relative serum creatinine basic value rises 113 μm of ol/L (201-88=113), be increased to 2.3 times (201/88=2.3 doubly) of serum creatinine basic value, now produce the early warning of II level, early warning information is sent to respectively three terminals at heart surgical department attending doctor workstation, Nephrology dept.'s acute injury of kidney workstation, Pharmacy's acute injury of kidney workstation place simultaneously, start the training consultation of doctors, kidney injury reason and therapeutic scheme are discussed.If the ramp-up rate of serum creatinine is very fast, directly reach more than 3 times (such as reaching 300 μm of ol/L) of serum creatinine basic value, then automatically send III level early warning, except the consultation of doctors of startup training, prompting attending doctor carries out assessment and the monitoring of acute injury of kidney complication immediately, comprises potassemia, metabolic acidosis, cardiac load etc.
In sum, the present invention has following technique effect:
1, the present invention can carry out automatic early-warning to acute injury of kidney, the timely diagnosing acute injury of kidney of paramedical personnel, improve the diagnosis of current clinical disease course not in time, intervene present situation not in time, effectively prevent patient's course of disease from worsening further;
2, system provided by the invention has simple to operate, and expansion is convenient, shows the advantages such as directly perceived.
Although above to invention has been detailed description, the present invention is not limited thereto, those skilled in the art of the present technique can carry out various amendment according to principle of the present invention.Therefore, all amendments done according to the principle of the invention, all should be understood to fall into protection scope of the present invention.
Claims (10)
1. acute injury of kidney early warning system in hospital, is characterized in that, comprising:
Pick-up unit, for detecting serum creatinine value, and using the serum creatinine value that obtains in front detection as serum creatinine basic value, will detect the serum creatinine value that obtains as serum creatinine detected value in latter seven days;
Calculation element, for according to described serum creatinine basic value and described serum creatinine detected value, determines that serum creatinine raises multiple;
Advanced warning grade determining device, for raising multiple according to described serum creatinine, determines acute injury of kidney advanced warning grade;
Warning device, for according to determined acute injury of kidney advanced warning grade, is sent to corresponding workstation by early warning information.
2. system according to claim 1, is characterized in that, described calculation element, by described serum creatinine detected value and described serum creatinine basic value being divided by, obtaining serum creatinine and raises multiple.
3. system according to claim 2, is characterized in that, described calculation element also for described serum creatinine detected value and described serum creatinine basic value being subtracted each other, obtains serum creatinine elevation amplitude.
4. the system according to claim 1-3 any one, it is characterized in that, described serum creatinine is raised multiple and compares with default first multiple threshold value, default second multiple threshold value and default triple threshold value respectively by described advanced warning grade determining device, and according to comparative result, determine acute injury of kidney advanced warning grade.
5. system according to claim 4, is characterized in that, be more than or equal to default first multiple threshold value if described serum creatinine raises multiple and be less than default second multiple threshold value, then described advanced warning grade determining device determination acute injury of kidney advanced warning grade is one-level.
6. system according to claim 5, it is characterized in that, described advanced warning grade determining device is also more than or equal to default serum creatinine elevation amplitude threshold value for the serum creatinine elevation amplitude in two days, and described serum creatinine raises multiple when being less than default second multiple threshold value, determines that acute injury of kidney advanced warning grade is one-level.
7. system according to claim 4, is characterized in that, be more than or equal to default second multiple threshold value if described serum creatinine raises multiple and be less than default triple threshold value, then described advanced warning grade determining device determination acute injury of kidney advanced warning grade is secondary.
8. system according to claim 4, is characterized in that, if described serum creatinine raises multiple be more than or equal to default triple threshold value, then described advanced warning grade determining device determination acute injury of kidney advanced warning grade is three grades.
9. system according to claim 8, it is characterized in that, described advanced warning grade determining device is also for comparing described serum creatinine detected value and default serum creatinine threshold value, if described serum creatinine detected value is more than or equal to default serum creatinine threshold value, then determine that acute injury of kidney advanced warning grade is three grades.
10. system according to claim 8, it is characterized in that, described advanced warning grade determining device is also less than default serum creatinine elevation amplitude threshold value for the serum creatinine elevation amplitude in two days, and serum creatinine in seven days raises multiple when being less than default first multiple threshold value, determines that current needs carries out acute injury of kidney early warning.
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| CN111710425A (en) * | 2020-06-19 | 2020-09-25 | 复旦大学附属中山医院 | Method, system and device for evaluating cardiotoxicity of immune checkpoint inhibitor |
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