高龄老年患者急性肾损伤致病诱因及治疗转归分析  

nalysis of the pathogenic causes and treatment outcomes of acute kidney injury in 39 very old patients

作　　者：富小红[1] 杨继红[1] 贾静[1] 雷龙[1] 孙颖[1] 

机构地区：[1]卫生部北京医院肾内科,北京100730

出　　处：《中华老年医学杂志》2013年第11期1137-1140,共4页Chinese Journal of Geriatrics

基　　金：基金项目：北京市科委首都市民健康培育项目（Z131100004013042）

摘　　要：目的探讨高龄老年患者急性肾损伤（AKI）的临床特点，分析致病诱因及治疗转归情况，以期提高高龄老年人AKI的诊治水平。方法观察2013年1—6月在我院老年医学部诊治的39例高龄老年（≥80岁）患者发生AKI的临床情况，随访3个月，对致病诱因及临床转归进行分析总结。结果39例高龄老年患者，男性31例，女性8例；平均年龄（93．5±4．6）岁；患有慢性肾脏疾病者占84．6％。发生AKI的致病诱因主要为感染（71．8％）、容量不足（48．7％）、心功能不全（23．1％）及低血压（15．4％）；64．1％的患者存在2～4种致病诱因。经积极治疗处理，69．2％患者肾功能好转或恢复，病死率25．6％（10／39），死亡原因主要为感染中毒性休克（3例）、多脏器功能衰竭（2例）、消化道大出血（2例）等。结论高龄老年患者多数在慢性肾脏病基础上发生AKI，AKI往往存在多种致病诱因，主要因素为感染，其次为容量不足和心功能不全。及时发现、纠正诱发因素，积极对症支持治疗，多数高龄老年AKI患者能够恢复。感染中毒性休克为死亡的首要原因。jective To investigate the clinical characteristics, pathogenic causes and treatment outcomes of acute kidney injury （AKI） in very old patients in order to improving the diagnosis and treatment. Methods 39 AKI patients aged 980 years in the department of geriatric medicine of our hospital were enrolled and followed up for 3 months. Clinical and laboratory data were analyzed and the pathogenic causes as well as the treatment outcomes were summarized. Results Among the 39 very old patients, 31（79.5%） were male, 8（20.5%） were female, and the mean age was （93.5%4. 6） years. 33（84. 6%）patients had chronic kidney diseases. The pathogenic causes of AKI were mainly as follows., urological infections （71. 8%）, blood volume deficiency （48. 7%）, cardiac dysfunction （23.1 %） and hypotension （15.4 %）. 2 to 4 pathogenic causes were co-present in 64.1% patients. Renal function was improved and recovered in 69.2 % patients and the death rate was 25.6% after treatment. The main causes of death were septic shock （30.0%）, multiple organ failure （20.6 %）, massive gastrointestinal hemorrhage （20.0%） et ai. Conclusions Most of the very old patients may suffer from AKI on the basis of chronic kidney disease. AKI is often induced by multiple pathogenic causes. The main factors leading to AKI are urological infections, followed by blood volume deficiency and cardiac dysfunction. Most patients with AKI can recover after the precipitating factors are removed and supportive treatments are administered in time. Septic shock is the main cause of death.

关 键 词：老年人 80岁以上 急性肾功能不全 危险因素 

分 类 号：R692[医药卫生—泌尿科学]