急性肾功能衰竭预后危险因素研究

Risk factors on prognosis of acute renal failure.

目的探讨影响急性肾功能衰竭(ARF)患者肾功能恢复率、病死率的危险因素,以指导诊疗,改善预后。方法通过Logistic回归等方法回顾性分析44例ARF患者的多系统器官功能衰竭(MSOF)发生率,比较高、低分解代谢、伴否MSOF的ARF患者其肾功能恢复率及病死率。结果高、低分解代谢型ARF患者肾功能恢复率、病死率差异均有显著性(P<0.01、P<0.05)。伴否MSOF的ARF患者间其肾功能恢复率,病死率差异均有显著性(均为P<0.01)。脏器衰竭数目与肾功能恢复率呈显著负相关(r=-0.617,P<0.01),与病死率呈显著正相关(r=0.78,P<0.01)。低分解代谢型ARF患者肾功能恢复率是高分解代谢型的13.7倍,不伴MSOF的ARF患者肾功能恢复率是伴MSOF者的27倍,伴MSOF的ARF患者其病死率是不伴MSOF者的68.7倍。结论对ARF患者应积极寻找并去除导致高分解代谢的原发病因,治疗选药时避免使用损害肾外脏器药物,力争不伴发或少伴发MSOF,这对改善ARF预后有利。

Objective To analyze the risk factors influencing the recovery rate of renal function and the mortality of acute renal failure （ARF） patients. Methods Logistic regression analysis was conducted to analyze the incidence of multiple system organ failure （ MSOF ） , the recovery rate of renal function, the mortality and low/high catabolism. Results The recovery rate of renal function was significantly different between high and low catabolic ARF patients （ P 〈0. 01 ） and so was mortality （ P 〈0.05 ）. The recovery rate of renal function was significantly dif- ferent in patients with and without MSOF and so was mortality （ P 〈 0.01 ）. The number of function-failure organs was significantly negatively correlated with the recovery rate of renal function （r = -0. 617, P 〈 0.01 ） mid positively associated with mortality （ r =0.78, P 〈 0.01）. The recovery rate of renal function in ARF patients with low-catabolism was 13.7 times of that with high-catabolism,the recovery rate of renal function in ARF patients without MSOF was 27 times of that with MSOF, and the mortality of those with MSOF was 68.7 times of that without MSOF. Conclusion Early detection and management of the primary causes of high-catabolism in ARF patients and prevention of multiple organ failure may improve the outcomic of ARF.