伴有多脏器功能障碍的急性肾损伤老年患者临床特点分析(1)
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[摘要] 目的：对伴有多脏器功能障碍综合征的急性肾损伤老年患者临床特点进行分析。方法：对比伴有多脏器功能障碍的急性肾损伤老年患者(67例)和非老年患者(31例)，分析其病因、病情发展、预后，探讨影响伴有多脏器功能障碍的急性肾损伤老年患者预后的因素。结果：老年组患者中伴有慢性基础病的总比例高达98.5%，并发症中伴有严重感染的比例为73.1%。老年组患者预后明显比非老年组差，肾功能恢复率为9.0%，病死率为73.1%。结论：伴有多脏器功能障碍的急性肾损伤老年患者常伴有慢性基础疾病和严重感染，治疗中病情恢复缓慢，且预后差。
[关键词] 急性肾损伤；多脏器功能障碍综合征；老年患者
[中图分类号] R692 [文献标识码] A [文章编号] 1673-7210(2011)12(b)-065-03
Clinical characteristics of elder patients with acute renal failure complicated with multiple organ dysfunction syndrome
GAO Zhuo, LIU Dong, LI Xinlun, LUN Lide*
Department of Nephrology, Air Force General Hospital, Beijing 100142, China
[Abstract] Objective: To analyze the clinical characteristics of the elderly patients with acute renal failure complicated with multiple organ dysfunction syndrome. Methods: 67 elderly patients and 31 non-elderly patients with acute renal failure complicated with multiple organ dysfunction syndrome were included. The different etiologies, progression of the disease and prognosis between the two groups were compared, and the related clinical factors to elderly patients′ outcome were explored. Results: The patients accompanied by chronic underlying diseases was 98.5%, and complicated with severe infection was 73.1%. Prognosis of the elderly patients was significantly worse than non-elderly group. The recovery rate of renal function was 9.0%, mortality was 73.1%. Conclusion: The elderly patients are often accompanied by chronic underlying diseases and severe infections, the recovery of disease is slow, and the prognosis is poor.
[Key words] Acute kidney injury; Multiple organ dysfunction syndrome; Elderly patients
近年来，急性肾损伤在医院内的发生率有增高趋势[1]，随着全社会人口老龄化，老年患者急性肾损伤的发生率增加更为明显，这可能与老年患者寿命延长、各脏器功能减退、常常合并多种慢性基础疾病如高血压、糖尿病、心脑血管疾病、肿瘤等有关。老年急性肾损伤患者一般病情较重，常伴有多脏器功能障碍综合征(MODS)，如果早期不积极干预治疗，预后极差。因此，探讨伴有多脏器功能障碍的老年急性肾损伤患者的病情特点，对于减少其危险因素、早期诊断、积极合理治疗、改善预后具有重要意义。现就我院近年来伴有多脏器功能障碍的急性肾损伤的老年患者病情进行分析总结，报道如下：
1 资料与方法
1.1 一般资料
选取2007年12月～2009年12月在我院住院明确诊断为急性肾损伤并伴有MODS的老年患者67例，同时以诊断为急性肾损伤并伴有MODS的非老年患者31例为对照。老年患者年龄均在65岁以上(含65岁)，非老年患者年龄在18~64岁之间。所有患者均进行床旁连续性血液净化治疗3 d以上，治疗时即有急性肾损伤伴MODS或开始只有急性肾损伤而随病情发展短期内出现MODS。MODS的诊断标准参照Marshall标准(1995年)[2]确定。急性肾损伤诊断标准参考ADQI新的诊断标准[3]。AKI标准为48 h内血肌酐上升0.3 mg/d(25 mmol/L)或较原先水平增高50%，或尿量减少[尿量<0.5 ml/(kg·h)，时间超过6 h]。
1.2 方法
1.2.1 连续性血液净化治疗具体方法 用聚砜膜进行前稀释连续静静脉血液滤过(CVVH)。根据患者病情，白天在床边治疗8～12 h，输入16～24 L碳酸氢盐置换液；有高分解代谢时则24 h不间断 ......
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