高原地区急性肾功能衰竭临床分析

Clinical analysis of patients with actue renal failure at high altitude

目的总结高原地区住院的急性肾功能衰竭(ARF)患者病因、临床特点以及影响预后的因素。方法回顾性分析西藏军区总医院2001年5月至2006年4月收治的ARF患者临床资料。结果共收治ARF患者148例,其中男性85例,女性63例,年龄(42.4±18.1)岁;其中医院获得性ARF占52.7%,5年来其所占比率有逐渐增加的趋势。肾前性ARF 48例(32.4%),以急性高原病最常见,占20例。肾性ARF 90例(印.8%),其中小球及微血管病变24例,急性肾小管坏死53例,急性间质性肾炎12例,单肾肾挫伤1例。由药物导致的肾损害39例,占肾性ARF的43.3%。肾后性10例(6.8%),病因主要为结石。患者总病死率为42.6%,其中的医院获得性ARF患者病死率(55.1%)明显高于社区获得性ARF患者(28.6%)(P<0.01);透析治疗与未透析治疗患者的病死率差异无统计学意义(P>0.05)。单因素分析显示,年龄、少尿或无尿、血尿、血红蛋白和器官衰竭数是影响预后的因素,多因素Logistic回归分析显示年龄、器官衰竭数和血红蛋白是影响病死率的因素。结论急性高原病和肾毒性药物导致的ARF在高原ARF患者中多见。医院获得性ARF发病率和病死率明显增加。预防多脏器功能不全综合征的发生是降低ARF病死率的关键。

Objective To analyze the etiologies, chnical characteristics and prognostic factors of patients with acute renal failure （ARF） admitted to the hospital at high altitude. Method This retrospective study included clinical data of patients with acute renal failure in the General Hospital of Tibet Military Command from May 2001 to April, 2006. Results There were 85 male patients and 63 female patients with mean age （42.4 ± 18.1） years old. Among 148 patients with acquired ARF, 52.7% was iatrogenic or nosocomal origin, demonstrating a trend of increasing. The ARF included pre-renal （ n = 48, 32.4% ）, renal parenchymal （ n = 90, 60.8%） and post-renal （ n = 10, 6.8%） in origin. Acute high altitude sickness （ n = 20） was the major causes of pre-renal ARF. Renal parenchymal ARF could be classified into glomerular vascular lesions （ n = 24）, acute tubular necrosis （ n = 53）, acute interstitial nephritides （ n = 12）, and contusion of unitesticle （ n = 1）. of 90 cases of renal parenchymal ARF, 39 patients （43.3 % ） were induced by medicines. Lithiasis was the major causes of post-renal ARF. The mortality of ARF in our study was 42.6%. The mortality of patients contracted ARF in hospital was much higher than that of patients community ARF in community （55.1 vs 23.6%; P = 0.01 ）. There was no significant differences of the mortality between the patients with and without dialysis treatment. Univariate analysis showed that prognosis was correlated with age, the presence of hematuria and oliguria or anuria Hb, and the number of organ system failures. The logistic regression showed that age, Hb and the number of organ system dysfunction were the predictors of mortality. Conclusions The major causes of ARF at high altitude were acute high altitude sickness and the use of medicines with nephrotoxicity. The morbility and mortality of nosocomisl ARF increased significantly. Prevention of MODS is a key management to decrease mortality in severe ARF.