甘露醇诱导1234例急性肾衰竭的临床探讨

Clinical analysis of 1234 cases with mannitol-induced acute renal failure

目的探讨甘露醇(mannitol,MT)导致急性肾衰竭(acute renal failure,ARF)的发病特点、临床表现、死亡率、死亡原因以及预后因素。方法通过维普全文数据库以及万方全文数据库,检索1980～2002年间国内相关文献81篇,对文章报道的1 234例MT致ARF患者进行回顾性分析。结果①MT致ARF的发病率为6.73%,出现ARF的平均年龄为(60.85±10.38)岁。其中76.19%的ARF患者原发病为脑出血、脑梗死;②发生ARF的患者MT日平均用量为(253.82±42.46)g,累积剂量为(1034.37±104.82)g;③80%患者出现少尿,50%出现血尿;④发生ARF后患者的总死亡率为26.15%;多器官功能衰竭(41.07%)、脑疝(28.57%)是主要死亡原因;⑤甘露醇日用量>200g的ARF患者死亡率(45.31%)显著高于日用量<200g者(10.87%);⑥发生ARF后,透析患者的死亡率(17.01%)显著低于未透析者(26.69%)。结论①老年人易于发生MT相关性的ARF;原发病为脑出血和脑梗死患者使用MT后ARF的发生率高;②少尿、无尿和血尿是最主要的临床表现;③发生ARF后患者的总死亡率为26.15%,死亡原因主要是多器官功能衰竭和脑疝;④MT日用量超过200g的ARF患者死亡率高;透析可以改善患者的预后。

Objective To study the clinical characteristics,manifestations,mortality,lethal causes and prognosis of mannitol（MT）-induced acute renal failure（ARF）.Methods We retrospectively analyzed the data of 1234 MT-induced ARF cases published in China's Mainland in 81 literatures during the period of 1980 to 2002.Results ①In 5981 cases treated with MT,the incidence of MT-induced ARF was 6.73%.The average age of MT-induced ARF cases was（60.85±10.38） years.In 76.19% of MT-induced ARF cases,the primary diseases were cerebral hemorrhage and cerebral infarction.② In MT-induced ARF cases,the average daily dosage and cumula-tive dosage of MT were（253.82±42.46）g and（1034.37±104.82）g,respectively.③ Oliguria was found in 80%,and hematuria in 50% of the patients.④The mortality rate of MT-induced ARF was 26.15%,and the main causes leading to death were multi-organ function failure（41.07%） and cerebral hernia（28.57%）.⑤ The mortality rate was 45.31% in patients treated with MT more than 200g daily,much higher than the rate of 10.87% in those used MT less than 200g daily.⑥ The mortality rate was 17.01% in MT-induced ARF patients treated with dialysis.In contrast,the rate was 26.69% in those without dialysis.Conclusions ① Factors prone to MT-induced ARF are age of more than 60,cerebral hemorrhage and cerebral infarction.② The principal manifestations of MT-induced ARF are oliguria and hematuria.③The mortality rate of MT-induced ARF was 26.15%,and multi-organ function failure and cerebral hernia are the two main causes leading to death.④ The mortality rate increases in patients treated with mannitol more than 200g daily.Dialysis is useful in improving their prognosis.