老年患者住院期间痛风发作的临床特点及其并发下肢深静脉血栓的情况分析  

Analysis of gout attack and its complications in hospitalized elderly patients

作　　者：李娅 曾平 朱鸣雷 刘晓红 李冬晶 Li Ya;Zeng Ping;Zhu Minglei;Liu Xiaohong;Li Dongjing(Department of Health Care,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院老年医学科保健医疗部,北京100730 [2]中国医学科学院北京协和医学院北京协和医院老年医学科老年医学科,北京100730

出　　处：《中国临床保健杂志》2018年第3期398-401,共4页Chinese Journal of Clinical Healthcare

基　　金：中央保健重点科研项目(W2015ZD03)

摘　　要：目的分析老年住院患者急性痛风发作及其并发症的诱因,避免出现类似可诱发住院获得性问题的因素。方法回顾性分析6例老年患者住院期间急性痛风发作及下肢深静脉血栓形成(DVT)的临床特点及诱因。结果 6例患者年龄(69±6)岁,均为男性,均有高尿酸血症,入院时血尿酸(582±106)μmol/L,5例既往有痛风病史,均无DVT病史。病因分析:急性感染性疾病入院3例,慢性病入院3例;住院时间(26±17)d,同期老年科住院日(16±5)d;合并代谢性疾病6例、心脏疾患3例、慢性肾功能不全2例、肺部疾患1例;入院时红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)均升高。诱因分析:入院后新增药品广谱抗菌药物3例、他汀类3例、阿卡波糖3例和血管紧张素转化酶抑制剂2例。均于入院初期接受多项外出检查,均因代谢性疾病调整饮食,2例明确有活动减少。痛风发作表现:5例于入院1周内发作,4例为多关节炎,2例伴发热。6例DVT确诊于痛风发作后(2.7±1.4)d,均为下肢远端静脉受累,其中5例为小腿肌间静脉受累。结论老年痛风或高尿酸血症患者住院医源性问题有诱发痛风发作风险,带来DVT等并发症,延长住院日,值得引起注意。Objective To detect the possible causes of acute gout attack and its complications among hospitalized elderly patients,and in order to avoid those factors that can lead to hospital acquired conditions （HACs）. Methods The clinical manifestations and causes of 6 cases of elderly patients with acute gout attack and lower extremity DVT during hospital stay were analyzed retrospectively. Results ①The average age was （69±6） years.All of the six cases were male and with the history of hyperuricemia.Five cases were with gout.②Etiological factors analysis：Three cases were admitted to hospital with acute infectious diseases,and another three cases with chronic diseases.Other diseases combined were metabolic diseases,heart diseases,chronic renal failure and pulmonary disease.ESR and hs-CRP tested on admission were all elevated.③Causative factors analysis：drugs added after hospitalized were antibiotics,statins,acarbosesand ACE inhibitors.After admission,all patients received several examinations outside of the ward and adjusted diet because of metabolic diseases. ④Clinical features：five cases of gout attack occurred within one week.Four cases were polyarthritis,while two cases with fever.All cases were with the distal lower extremity venous involved,and five of those were calf intermuscular DVT. Conclusion Elderly hospitalized patients with a history of gout or hyperuricemia are at risk for the onset of acute gout attack caused by HACs,which may cause complications such as DVT and prolong hospital stay.

关 键 词：医原性疾病 住院病人 深静脉血栓形成 痛风 住院获得性问题 老年人 

分 类 号：R589.7[医药卫生—内分泌]