CAJ | 학술논문

目的探讨高龄老年患者急性肾损伤(AKI)的临床特点,分析致病诱因及治疗转归情况,以期提高高龄老年人AKI的诊治水平. 方法观察2013年1-6月在我院老年医学部诊治的39例高龄老年(≥80岁)患者发生AKI的临床情况,随访3个月,对致病诱因及临床转归进行分析总结. 结果 39例高龄老年患者,男性31例,女性8例;平均年龄(93.5±4.6)岁;患有慢性肾脏疾病者占84.6％.发生AKI的致病诱因主要为感染(71.8％)、容量不足(48.7％)、心功能不全(23.1％)及低血压(15.4％);64.1％的患者存在2～4种致病诱因.经积极治疗处理,69.2％患者肾功能好转或恢复,病死率25.6％(10/39),死亡原因主要为感染中毒性休克(3例)、多脏器功能衰竭(2例)、消化道大出血(2例)等. 结论高龄老年患者多数在慢性肾脏病基础上发生AKI,AKI往往存在多种致病诱因,主要因素为感染,其次为容量不足和心功能不全.及时发现、纠正诱发因素,积极对症支持治疗,多数高龄老年AKI患者能够恢复.感染中毒性休克为死亡的首要原因.
목적 탐토고령노년환자급성신손상(AKI)적림상특점,분석치병유인급치료전귀정황,이기제고고령노년인AKI적진치수평. 방법 관찰2013년1-6월재아원노년의학부진치적39례고령노년(≥80세)환자발생AKI적림상정황,수방3개월,대치병유인급림상전귀진행분석총결. 결과 39례고령노년환자,남성31례,녀성8례;평균년령(93.5±4.6)세;환유만성신장질병자점84.6％.발생AKI적치병유인주요위감염(71.8％)、용량불족(48.7％)、심공능불전(23.1％)급저혈압(15.4％);64.1％적환자존재2～4충치병유인.경적겁치료처리,69.2％환자신공능호전혹회복,병사솔25.6％(10/39),사망원인주요위감염중독성휴극(3례)、다장기공능쇠갈(2례)、소화도대출혈(2례)등. 결론 고령노년환자다수재만성신장병기출상발생AKI,AKI왕왕존재다충치병유인,주요인소위감염,기차위용량불족화심공능불전.급시발현、규정유발인소,적겁대증지지치료,다수고령노년AKI환자능구회복.감염중독성휴극위사망적수요원인.
Objective To investigate the clinical characteristics,pathogenic causes and treatment outcomes of acute kidney injury (AKI) in very old patients in order to improving the diagnosis and treatment.Methods 39 AKI patients aged ≥80 years in the department of geriatric medicine of our hospital were enrolled and followed up for 3 months.Clinical and laboratory data were analyzed and the pathogenic causes as well as the treatment outcomes were summarized.Results Among the 39 very old patients,31(79.5％) were male,8(20.5％) were female,and the mean age was (93.5±4.6) years.33 (84.6％)patients had chronic kidney diseases.The pathogenic causes of AKI were mainly as follows:urological infections (71.8％),blood volume deficiency (48.7％),cardiac dysfunction (23.1％) and hypotension (15.4％).2 to 4 pathogenic causes were co present in 64.1％ patients.Renal function was improved and recovered in 69.2 ％ patients and the death rate was 25.6％ after treatment.The main causes of death were septic shock (30.0％),multiple organ failure (20.0％),massive gastrointestinal hemorrhage (20.0％) et al.Conclusions Most of the very old patients may suffer from AKI on the basis of chronic kidney disease.AKI is often induced by multiple pathogenic causes.The main factors leading to AKI are urological infections,followed by blood volume deficiency and cardiac dysfunction.Most patients with AKI can recover after the precipitating factors are removed and supportive treatments are administered in time.Septic shock is the main cause of death.