中国血液净化

中国血液净化 ›› 2016, Vol. 15 ›› Issue (03): 164-167.doi: 10.3969/j.issn.1671-4091.2016.03.010

• 临床研究 • 上一篇    下一篇

老年急性肾衰竭患者临床特点分析

陈罡1,叶文玲1,秦岩1,陈丽萌1,苏颖1,于阳1,高瑞通1,袁群生1,李航1,李明喜1,李学旺1,李雪梅1   

  1. 北京协和医院肾内科
  • 收稿日期:2015-11-23 修回日期:2016-01-10 出版日期:2016-03-12 发布日期:2016-03-19
  • 通讯作者: 李雪梅 Lixmpumch@126.com E-mail:lixmpumch@163.com
  • 基金资助:

    国家科技支撑计划(2011BAI10B02 和2012BAJ18B03);首都医学发展科研基金(首发2011-4001-08)

The importance of acute renal failure in old patients: analysis of the clinical features in 507 cases with acute renal failure

  • Received:2015-11-23 Revised:2016-01-10 Online:2016-03-12 Published:2016-03-19

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摘要： 目的总结急性肾衰竭(acute renal failure，ARF)的临床特点及不同年龄段患者的差别。方法回顾性分析507 例临床、资料完整的ARF 病例，按年龄分组，分析ARF 的临床特点及不同年龄段患者的差别。结果年轻组146 例(28.8%)，中年组172 例(33.9%)，老年组189 例(37.3%)。①病因方面，老年组以肾前性因素为主，年轻组以肾性因素为主。不同年龄组在高血压(χ2=86.804,P＜0.001)、糖尿病(χ2=30.163,P＜0.001)、冠心病(χ2=70.752,P＜0.001)、心力衰竭(χ2=13.494,P=0.001)脑
血管病(χ2=31.387,P＜0.001)等基础疾病的发病率存在显著差别，老年患者发生比例居首位。②并发症方面，不同年龄组酸中毒的发生率存在显著差异(χ2= 10.393, P=0.006)，老年组更易发生。③不同年龄组的死亡(χ2=54.835,P＜0.001)、多脏器功能障碍(mulitiple organ dysfunction syndrome, MODS)(χ2=31.061, P＜0.001)、心功能障碍(χ2=32.593,P＜0.001)和肺功能障碍(χ2=15.447,P＜0.001)的发生率有显著差别，老年患者居首位。④通过Logistic 回归分析建立预后模型表明：即使代谢性酸中毒处于HCO3-降低而pH 值正常的阶段，仍是影响预后的危险因素(OR 2.636，95% CI 1.232～5.639，P=0.013)，MODS (OR 28.236 95% CI 14.946～53.344，P＜0.001)和少尿(OR 2.269，95% CI 1.263～4.075，P=0.006)也是影响预后的危险因素；血白蛋白(OR 0.936，95% CI 0.899～0.975，P=0.001)是预后的保护性因素。结论①老年患者基础肾功能差，基础疾病多，ARF 病因有别于非老年患者，以肾前性为主；②老年患者ARF 发生后，酸中毒、脏器衰竭的发生率和死亡率高于非老年患者。

关键词: 急性肾功能衰竭, 老年, 病因, 酸中毒, 白蛋白

Abstract: Purpose To summarize the clinical characters of patients with acute renal failure (ARF) and compare the difference among different age groups. Method The clinical data of 507 ARF patients with complete medical records were reviewed. Patient data were sorted by different age groups and then analyzed to summarize the clinical characters of ARF patients and compare the difference among different age groups. Results Young group consisted of 146 cases (28.8%), middle-aged group consisted of 172 cases (33.9%), and old group consisted of 189 cases (37.3%). ① The dominant causes were prerenal in the old group, but were intrinsic in the young group. The old group differed from other age groups in the frequency of underlying diseases, including hypertension (χ2=86.804, P＜0.001), diabetes (χ2=30.163, P＜0.001), coronary heart disease (χ2= 70.752, P＜0.001), heart failure (χ2=13.494, P=0.001), and cerebrovascular disease (χ2=31.387, P＜0.001). ②The prevalence of acidosis as a complication of ARF was significantly different among the three age groups (χ2=10.393, P=0.006), which tended to happen more frequently in the old group. ③ The mortality (χ2=54.835, P＜0.001), as well as the prevalence of multiple organ dysfunction syndrome (χ2=31.061, P＜0.001), heart dysfunction (χ2=32.593, P＜0.001), and lung dysfunction (χ2=15.447, P＜0.001) were also significantly different among the three age groups, ranking the highest in the old group. ④Models were established to predict the prognosis of ARF after multivariate logistic regression analysis. The models interpreted that acidosis, even in the compensation stage, was the risk factor for ARF (P＜0.05). Multiple organ dysfunction syndrome (P＜0.001) and oliguria (P＜0.01) were also the risk factors for ARF, while albumin (P＜0.01) was the protective factor. Conclusion Elderly patients with poorer baseline renal function and higher frequency of underlying diseases were more likely to develop ARF, and the prevalence of acidosis and organ dysfunction were more likely to occur after ARF, resulting in the higher mortality in the old group.

Key words: acute renal failure, old age, etiology, metabolic acidosis, albumin