中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2009年
8期
661-664
,共4页
肾功能衰竭,急性%危重病
腎功能衰竭,急性%危重病
신공능쇠갈,급성%위중병
Kidney failure,acute%Critical illness
目的 了解老年内科危重症患者发生急性肾衰竭(ARF)的致病因素及转归.方法 对我院内科近10年老年(≥60岁)ARF患者的临床资料进行回顾分析,将老年患者分为院外获得性ARF(院外ARF)组和院内获得性ARF(院内ARF)组,并与同期内科非老年ARF患者进行比较.结果 (1)老年内科ARF患者381例,院外获得性ARF为218例(57.2%),医院获得性ARF为163例(42.8%),其中来自内科重症监护室153例(93.9%);(2)与院外ARF组比较,院内ARF组患者年龄较高.慢性基础疾病较多,伴发感染和/或心力衰竭的比率和病死率较高,ARF的程度较重;(3)院内ARF组的致病因素以感染及心力衰竭或心肌缺血为主;(4)院内ARF组死亡147例,死亡组伴慢性基础疾病、合并严重感染及心力衰竭、伴发老年多器官功能障碍综合征(MODS)者均多于存活组,危霞症程度(APACHEⅡ评分)更高,肾衰竭程度更重;(5)与非老年组比较,老年组院内ARF构成比、伴发MODS、APACHEⅡ评分及病死率均显著增高. 结论 老年危重症患者更易发生ARF,医院获得性ARF的主要诱因为感染,心力衰竭或严重心肌缺血,病死率较高.
目的 瞭解老年內科危重癥患者髮生急性腎衰竭(ARF)的緻病因素及轉歸.方法 對我院內科近10年老年(≥60歲)ARF患者的臨床資料進行迴顧分析,將老年患者分為院外穫得性ARF(院外ARF)組和院內穫得性ARF(院內ARF)組,併與同期內科非老年ARF患者進行比較.結果 (1)老年內科ARF患者381例,院外穫得性ARF為218例(57.2%),醫院穫得性ARF為163例(42.8%),其中來自內科重癥鑑護室153例(93.9%);(2)與院外ARF組比較,院內ARF組患者年齡較高.慢性基礎疾病較多,伴髮感染和/或心力衰竭的比率和病死率較高,ARF的程度較重;(3)院內ARF組的緻病因素以感染及心力衰竭或心肌缺血為主;(4)院內ARF組死亡147例,死亡組伴慢性基礎疾病、閤併嚴重感染及心力衰竭、伴髮老年多器官功能障礙綜閤徵(MODS)者均多于存活組,危霞癥程度(APACHEⅡ評分)更高,腎衰竭程度更重;(5)與非老年組比較,老年組院內ARF構成比、伴髮MODS、APACHEⅡ評分及病死率均顯著增高. 結論 老年危重癥患者更易髮生ARF,醫院穫得性ARF的主要誘因為感染,心力衰竭或嚴重心肌缺血,病死率較高.
목적 료해노년내과위중증환자발생급성신쇠갈(ARF)적치병인소급전귀.방법 대아원내과근10년노년(≥60세)ARF환자적림상자료진행회고분석,장노년환자분위원외획득성ARF(원외ARF)조화원내획득성ARF(원내ARF)조,병여동기내과비노년ARF환자진행비교.결과 (1)노년내과ARF환자381례,원외획득성ARF위218례(57.2%),의원획득성ARF위163례(42.8%),기중래자내과중증감호실153례(93.9%);(2)여원외ARF조비교,원내ARF조환자년령교고.만성기출질병교다,반발감염화/혹심력쇠갈적비솔화병사솔교고,ARF적정도교중;(3)원내ARF조적치병인소이감염급심력쇠갈혹심기결혈위주;(4)원내ARF조사망147례,사망조반만성기출질병、합병엄중감염급심력쇠갈、반발노년다기관공능장애종합정(MODS)자균다우존활조,위하증정도(APACHEⅡ평분)경고,신쇠갈정도경중;(5)여비노년조비교,노년조원내ARF구성비、반발MODS、APACHEⅡ평분급병사솔균현저증고. 결론 노년위중증환자경역발생ARF,의원획득성ARF적주요유인위감염,심력쇠갈혹엄중심기결혈,병사솔교고.
Objective To investigate the etiology, exacerbating factors and outcome of geriatric patients with acute renal failure (ARF) in emergency and critical internal medicine. Methods Clinical features of elderly inpatients with ARF who were diagnosed in internal medicine of our hospital during the past 10 years were retrospectively analyzed. Patients were divided into community-acquired ARF (CA-AFR) group and hospital-acquired ARF (HA-ARF) group. Comparisons between CA-ARF group and HA-ARF group, and between elderly patients and non-elderly patients with ARF in internal medicine were performed. Results Among 381 elderly ARF patients in internal medicine, there were 218 (57.2%) CA-ARF patients and 163 (42.8%) HA-ARF patients. Most of the HA-ARF patients (153 cases) were distributed in medical intensive care. Compared with CA-ARF group, patients in HA-ARF group were older, with more underlying diseases, a higher ratio of infections and/or heart failure and more severe acute renal failure. Infection and heart failure/severe myocardial isehemia were the major exacerbating factors for HA-ARF. Of the 163 patients with HA-ARF, 146 patients died and 17 patients survived. Patients in the death group had more underlying diseases, a higher ratio of severe infections and heart failure/severe myocardial ischemia, a higher ratio of cases with multiple organ dysfunction syndrome(MODS) and a higher score of APACHE Ⅱ.When compared with non-elderly patients with ARF, the elderly patients had a higher proportion ofHA-ARF, a higher ratio of MODS, a higher score of APACHEⅡ and a higher mortality of ARF.Conclusions The elderly critical patients are susceptible to HA-ARF with more chronic underlying diseases. Infection and heart failure/severe myocardial ischemia are the major exacerbating factors.The prognosis depends on the treatment of predisposing diseases and removal of exacerbating factors.
