甘露醇致不同年龄蛛网膜下腔出血患者急性肾损害的对比分析  

Comparative study of mannitol -induced acute kidney impairments in patients of different ages suffering from subarachnoid hemorrhage

作　　者：陈春富[1] 刘新峰[1] 孟宪志 贾海燕[3] 

机构地区：[1]南京军区南京总医院神经内科,210002 [2]解放军第四五六医院空勤科,济南250031 [3]济南军区总医院医务部,济南250031

出　　处：《中国危重病急救医学》2007年第12期727-730,共4页Chinese Critical Care Medicine

基　　金：江苏省自然科学基金资助项目（BK2004425）

摘　　要：目的对比分析不同年龄首次发生蛛网膜下腔出血（SAH）患者应用甘露醇致急性肾损害的临床特点。方法选择1989年2月2005年12月收治的SAH患者1361例，有94例合并甘露醇肾病，其中中年组（〈60岁）35例，老年组（〉60岁）59例。观察应用甘露醇后急性肾损害出现的时间、肾损害的预后、应用肾毒性药物情况以及甘露醇应用剂量和时间。结果老年组患者尿常规出现异常时间为应用甘露醇后4d（中位数），肾功能异常出现时间为5d（中位数），急性肾功能衰竭（ARF）出现时间为5d（中位数），ARF发生率为20．3％；中年组分别为7d、11d、9d和2．8％（P〈0．05或P〈0．01），说明老年患者对甘露醇的耐受性差，甘露醇肾病出现早、肾损害重、预后差。老年组有43例使用了速尿（占72．9％），总剂量为400mg（中位数）；中年组35例使用了速尿（占100．0％），总剂量为800mg（中位数），两组比较差异有统计学意义（P〈0．01）；大剂量甘露醇联合应用速尿的患者甘露醇肾病发生率低。老年组病死率为3．4％（2／59例），中年组无死亡病例。结论老年SAH患者应用甘露醇易于诱发急性肾损害，联合使用速尿对防止急性肾功能衰竭具有重要意义。Objective To analyze and compare the clinical characteristics of mannitol - induced acute renal function impairment in treatment of patients of different ages suffering from subarachnoid hemorrhage （SAH） for the first time. Methods This study was a review of 1 361 patients with available hospital records admitted to the division of neurology due to SAH from February 1989 to December 2005. Among them, 94 patients had acute renal function impairment as a result of mannitol administration. Of these patients, 35 patients were middle -aged （〈60 years old） and 59 patients of old age （〉60 years old）. The study included the time of appearance of renal function impairment after mannitol medication, its prognosis, the administration of nephrotoxic drugs, and the dose and duration of mannitol therapy. Results In old age group, abnormal renal function and urine routine appeared in 5 days （median）, and 4 days （median） respectively, and acute renal failure （ARF） was diagnosed in 5 days, and the incidence rate of ARF was 20.3% after treatment with mannitol. The respective event appeared 7 days, 11 days, 9 days and 2.8% （P〈0. 05 or P〈0. 01） respectively, in middle -aged group. The data indicated the elderly patients had poorer tolerance to mannitol, with earlier occurrence of mannitol nephrosis, poorer outcome of kidney impairment and worse prognosis. Forty -three patients （72.9 %） were treated with katlex （with a median of total dosage of 400 mg） in old -aged group, 35 patients （100. 0%） were treated with katlex （with a median of total dosage of 800 mg） in middle-aged group, and there was a significant difference between two groups （P〈0. 01）. The data indicated the incidence of mannitol nephrosis was lower in patients treated with large dosage of mannitol and katlex. The mortality was 3.4% （2/59 cases） and 0% （0/35 cases） in old -aged and middle -aged groups respectively （P=0. 528）. Conclusion The elderly patients have higher rate of mannitol - induced impair

关 键 词：蛛网膜下腔出血 甘露醇 渗透性肾病 肾功能衰竭 急性 

分 类 号：R686[医药卫生—骨科学]