中国血液净化

›› 2008, Vol. 7 ›› Issue (10): 546-548.

• 论著 • 上一篇    下一篇

甘露醇诱导1234例急性肾衰竭的临床探讨

刘智辉1 俞国庆2 谢福安2 陈 建   

  1. 上海交通大学附属第一人民医院肾内科
  • 收稿日期:2008-07-26 修回日期:1900-01-01 出版日期:2008-10-08 发布日期:2008-10-08

Clinical analysis of 1234 cases with mannitol-induced acute renal failure

LIU Zhi-hui1, YU Guo-qing2, XIE Fu-an2, CHEN Jian   

  1. 1Division of Nephrology, The First People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200080, 2Department of Nephrology, The Fuzhou General Hospital of Nanjing Military Command, Fuzhou, 350025,China
  • Received:2008-07-26 Revised:1900-01-01 Online:2008-10-08 Published:2008-10-08

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摘要： 目的 探讨甘露醇(mannitol，MT)导致急性肾功能衰竭(acute renal failure，ARF)的发病特点、临床表现、死亡率、死亡原因以及预后因素。方法 通过维普全文数据库以及万方全文数据库，检索1980～2002年间国内相关文献81篇，对文章报道的1234例MT致ARF患者进行回顾性分析。 结果 ①MT致ARF的发病率为6.73%，出现ARF的平均年龄为(60.85±10.38)岁。其中76.19%的ARF患者原发病为脑出血、脑梗塞；②发生ARF的患者MT日平均用量为(253.82±42.46)g，累积剂量为(1034.37±104.82)g；③80%患者出现少尿，50%出现血尿；④发生ARF后患者的总死亡率为 26.15%；多器官功能衰竭（41.07%）、脑疝(28.57%)是主要死亡原因；⑤甘露醇日用量＞200g的ARF患者死亡率(45.31%)显著高于日用量＜200g者(10.87%)；⑥发生ARF后，透析患者的死亡率(17.01%)显著低于未透析者(26.69%)。结论 ①老年人易于发生MT相关性的ARF；原发病为脑出血和脑梗塞者使用MT后ARF的发生率高；②少尿、无尿和血尿是最主要的临床表现；③发生ARF后患者的总死亡率为26.15%，死亡原因主要是多器官功能衰竭和脑疝；④MT日用量超过200g的ARF患者死亡率高；透析可以改善患者的预后。

关键词: 甘露醇, 急性肾功能衰竭, 透析

Abstract:

Objective To study the clinical characteristics, manifestations, mortality, lethal causes and prognosis of mannitol (MT)-induced acute renal failure (ARF). Methods We retrospectively analyzed the data of 1234 MT-induced ARF cases published in mainland China in 81 literatures during the period of 1980 to 2002. Results ① In 5981 cases treated with MT, the incidence of MT-induced ARF was 6.73%. The average age of MT-induced ARF cases was 60.85±10.38 years. In 76.19% of MT-induced ARF cases, the primary diseases were cerebral hemorrhage and cerebral infarction. ② In MT-induced ARF cases, the average daily dosage and cumulative dosage of MT were 253.82±42.46g and 1034.37±104.82g, respectively. ③ Oliguria was found in 80%, and hematuria in 50% of the patients. ④ The mortality rate of MT-induced ARF was 26.15%, and the main causes leading to death were multi-organ function failure (41.07%) and cerebral hernia (28.57%). ⑤ The mortality rate was 45.31% in patients treated with MT more than 200g daily, much higher than the rate of 10.87% in those used MT less than 200g daily. ⑥ The mortality rate was 17.01% in MT-induced ARF patients treated with dialysis. In contrast, the rate was 26.69% in those without dialysis. Conclusions ① Factors prone to MT-induced ARF are age of more than 60, cerebral hemorrhage and cerebral infarction. ② The principal manifestations of MT-induced ARF are oliguria and hematuria. ③ The mortality rate of MT-induced ARF was 26.15%, and multi-organ function failure and cerebral hernia are the two main causes leading to death. ④ The mortality rate increases in patients treated with mannitol more than 200g daily. Dialysis is useful in improving their prognosis.

Key words: Acute renal failure, Dialysis

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