老年急性肾损伤的病因特点与预后分析  

Etiologic Characteristics and Prognosis Analysis of Acute Kidney Injury in Elderly Patients

作　　者：杨新军[1] 汪晶华[1] 林静[1] 陈云爽[1] 赵维[1] 刘宇[1] 王丽晖[1] 吴广礼[1] YANG Xin-jun;WANG Jing-hua;LIN Jing;CHEN Yun-shuang;ZHAO Wei;LIU Yu;WANG Li-hui;WU Guang-li(Department of Nephrology,Bethune International Peace Hospital of PLA,Shijiazhuang 050082,China)

机构地区：[1]解放军白求恩国际和平医院肾脏病科,石家庄050082

出　　处：《临床误诊误治》2018年第9期73-77,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨老年急性肾损伤(acute kidney injury,AKI)的病因特点与预后因素。方法选择我院97例老年AKI作为观察组,同期收治的108例成年AKI作为对照组。记录两组基础疾病及住院期间并发症发生情况,比较入院时格拉斯哥昏迷指数(GCS)评分、连续器官衰竭(SOFA)评分、急性生理与慢性健康(APACHE)评分,分析病因特点及预后因素。结果与对照组比较,观察组高血压病、冠心病、脑血管疾病、糖尿病、心力衰竭、慢性支气管炎发病率及住院期间低蛋白血症、感染、多器官功能障碍综合征发生率明显升高,差异有统计学意义(P<0.05)。与对照组比较,观察组入院时肾小球滤过率降低,GCS评分、SOFA评分、APACHE评分升高,差异有统计学意义(P<0.05)。观察组治愈41例(42.3%),好转28例(28.9%),未愈15例(15.5%),死亡13例(13.4%);对照组治愈63例(58.3%),好转38例(35.2%),未愈5例(4.6%),死亡2例(1.9%)。两组肾前性因素及AKI 3期与预后相关。结论老年AKI患者以肾前性为主,早期明确病因并治疗可有效改善预后,提高治疗成功率。Objective To discuss the etiologic characteristics and prognostic factors of acute kidney injury（AKI） in elderly patients. Methods A total of 97 elderly AKI patients admitted to Bethune International Peace Hospital of PLA were selected as observation group, and 108 adult AKI patients who were admitted in the same period as control group. The underlying diseases and the complications of the two groups were recorded. Scores of Glasgow Coma Scale （GCS）, Sequential Organ Failure Assessment （SOFA）, and Acute Physiologic and Chronic Health Evaluation （APACHE） were compared, and the etiologic characteristics and prognostic factors were analyzed. Results Compare with the control group, the observation group had higher incidence of primary hypertension, coronary heart disease, cerebrovascular disease, diabetes mellitus, heart failure and chronic bronchitis, and higher incidence of hypoproteinemia, infection, and multiple organ dysfunction syndrome （MODS） during hospital stay. The difference between two groups was statistically significant （ P 〈0.05）. As compared with those of control group, patients of observation group had lower Glomerular filtration rate （eGFR）, and higher scores of GCS, SOFA and APACHE at admission, and the difference was statistically significant （ P 〈0.05）.The cure rate, the improvement rate, failure rate and mortality rate of observation group were 42.3% （ n =41）, 28.9% （ n =28）, 15.5% （ n =15）, and 13.4% （ n =13）, respectively. The above indicators of control group were 58.3% （ n =63）, 35.2% （ n =38）,4.6% （ n =5）, and 1.9% （ n =2）. Pre-renal factors and AKI stage III were associated with prognosis in both groups （ P 〈0.05）. Conclusion The main pattern of AKI in the elderly was pre-renal AKI. Early diagnosis and treatment may improve the prognosis and success rate of the treatment.

关 键 词：急性肾损伤 老年人 预后 

分 类 号：R692.5[医药卫生—泌尿科学]