中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
34期
2715-2718
,共4页
李青霖%程庆砾%马强%王小丹%敖强国%赵佳慧%杜婧%刘胜%张晓英
李青霖%程慶礫%馬彊%王小丹%敖彊國%趙佳慧%杜婧%劉勝%張曉英
리청림%정경력%마강%왕소단%오강국%조가혜%두청%류성%장효영
肾功能不全,急性%老年人%预后%危险因素
腎功能不全,急性%老年人%預後%危險因素
신공능불전,급성%노년인%예후%위험인소
Renal insufficiency,acute%Aged%Prognosis%Risk factors
目的 对老年急性肾损伤(AKI)患者进行随访观察,分析AKI的短期预后及危险因素.方法 选择2008年1月-2009年12月就诊于解放军总医院的232例老年AKI患者的病历资料,根据发生AKI后28 d和29 d至3个月时患者的生存情况,将患者病历资料分成死亡组和存活组进行分析,采用t检验或Pearson x2检验筛查出影响预后的因素,将有统计学意义的因素为自变量进行多因素Logistic回归分析,判断各因素对死亡风险的影响.结果 232例老年AKI患者,平均年龄(86.7±5.3)岁.28 d内死亡38例(16.4％),3个月内共死亡57例(24.6％).感染(43.1％)为最常见病因,其次为低血容量(19.0％)、肾毒性药物(16.8％)和心血管事件(15.1％)等.多因素Logistic 回归分析显示低体质指数(BMI)、少尿、机械通气、血清白蛋白降低、血清肌酐(Scr)峰值(＞246.5μmol/L)是影响AKI患者28 d时预后的因素(均P＜0.05)；低BMI、血清白蛋白降低及血尿素氮增高是影响AKI患者29 d至3个月时预后的因素(均P＜0.05).结论 感染、低血容量、肾毒性药物、心血管事件等是诱发AKI最常见的原因；低BMI、少尿、机械通气、血清白蛋白降低、血尿素氮增高、Scr峰值(＞246.5 μmol/L)是影响AKI患者预后的危险因素.
目的 對老年急性腎損傷(AKI)患者進行隨訪觀察,分析AKI的短期預後及危險因素.方法 選擇2008年1月-2009年12月就診于解放軍總醫院的232例老年AKI患者的病歷資料,根據髮生AKI後28 d和29 d至3箇月時患者的生存情況,將患者病歷資料分成死亡組和存活組進行分析,採用t檢驗或Pearson x2檢驗篩查齣影響預後的因素,將有統計學意義的因素為自變量進行多因素Logistic迴歸分析,判斷各因素對死亡風險的影響.結果 232例老年AKI患者,平均年齡(86.7±5.3)歲.28 d內死亡38例(16.4％),3箇月內共死亡57例(24.6％).感染(43.1％)為最常見病因,其次為低血容量(19.0％)、腎毒性藥物(16.8％)和心血管事件(15.1％)等.多因素Logistic 迴歸分析顯示低體質指數(BMI)、少尿、機械通氣、血清白蛋白降低、血清肌酐(Scr)峰值(＞246.5μmol/L)是影響AKI患者28 d時預後的因素(均P＜0.05)；低BMI、血清白蛋白降低及血尿素氮增高是影響AKI患者29 d至3箇月時預後的因素(均P＜0.05).結論 感染、低血容量、腎毒性藥物、心血管事件等是誘髮AKI最常見的原因；低BMI、少尿、機械通氣、血清白蛋白降低、血尿素氮增高、Scr峰值(＞246.5 μmol/L)是影響AKI患者預後的危險因素.
목적 대노년급성신손상(AKI)환자진행수방관찰,분석AKI적단기예후급위험인소.방법 선택2008년1월-2009년12월취진우해방군총의원적232례노년AKI환자적병력자료,근거발생AKI후28 d화29 d지3개월시환자적생존정황,장환자병력자료분성사망조화존활조진행분석,채용t검험혹Pearson x2검험사사출영향예후적인소,장유통계학의의적인소위자변량진행다인소Logistic회귀분석,판단각인소대사망풍험적영향.결과 232례노년AKI환자,평균년령(86.7±5.3)세.28 d내사망38례(16.4％),3개월내공사망57례(24.6％).감염(43.1％)위최상견병인,기차위저혈용량(19.0％)、신독성약물(16.8％)화심혈관사건(15.1％)등.다인소Logistic 회귀분석현시저체질지수(BMI)、소뇨、궤계통기、혈청백단백강저、혈청기항(Scr)봉치(＞246.5μmol/L)시영향AKI환자28 d시예후적인소(균P＜0.05)；저BMI、혈청백단백강저급혈뇨소담증고시영향AKI환자29 d지3개월시예후적인소(균P＜0.05).결론 감염、저혈용량、신독성약물、심혈관사건등시유발AKI최상견적원인；저BMI、소뇨、궤계통기、혈청백단백강저、혈뇨소담증고、Scr봉치(＞246.5 μmol/L)시영향AKI환자예후적위험인소.
Objective To explore the risk factors and short-term outcomes of acute kidney injury (AKI) in elderly patients.Methods A total of 232 elderly AKI patients at Chinese PLA General Hospital from June 2008 to December 2009 were enrolled.They were divided into two groups according to their outcomes at 28 days and at 29 days to 3 months after AKI respectively.Their clinical data were analyzed to explore the risk factors and their effects on the outcomes of AKI.Results There were 215 males and 17 females with an average age of (86.7 ± 5.3) years.Thirty-eight cases (16.4％) died within 28 days after AKI and 57 (24.6％) died within 3 months.Infection (43.1％) was the major cause of AKI.The other causes included hypovolemia (19.0％),use of nephrotoxic drugs (16.8％) and cardiovascular events (15.1％) respectively.Logistic regression analysis revealed that low body mass index (BMI),oliguria,mechanical ventilation,hypoalbuminemia and peak serum level of creatinine (Scr ＞ 246.5 μmol/L) were the prognostic factors of AKI in those patients dying within 28 days after AKI (P ＜ 0.05).Low BMI,hypoalbuminemia and high blood level of urea nitrogen (BUN) were the prognostic factors of AKI in those patients dying within 29 days to 3 months after AKI (P ＜ 0.05).Conclusion Infection,hypovolemia,use of nephrotoxic drugs and cardiovascular events are common causes of AKI in elderly patients.Low BMI,oliguria,mechanical ventilation,hypoalbuminemia,high level of BUN and peak level of Scr (＞ 246.5 μmol/L) are the prognostic factors of AKI in elderly patients.
