两个时期急性肾衰竭病人的临床和预后研究

The analysis of clinic and prognosis in patients with acute renal failure in two periods

目的探讨两个时期急性肾衰竭(ARF)病人的复杂性因素变化和预后的关系,以找出两个时期死亡率差别的原因。方法回顾性地分析1990年至1997年(A时期)的155例和2000年至2007年(B时期)267例ARF病人的临床资料,比较其临床和预后变化。结果A、B两个时期病人的死亡率分别为47.7%和33.3%。B时期多脏器衰竭的发生率和器官衰竭数均明显低于A时期,B时期存在较多的慢性疾病状态,肾毒性物质和血透病人增多了,肺部疾病和手术在两个时期均占多数,多脏器衰竭、肺部疾病、肝病、手术后以及败血症对死亡率有明显影响。结论近些年,ARF病人总体年龄并无明显变化,但存在较多的慢性疾病状态,肾毒性物质和血透病人增多了,预后有明显改善。

Objective To determine whether any changes occurred in the complexity of illness or prognosis of acute renal failure （ARF） duing two periods, and to find some influencing factors of mortality. Methods A retrospective comparison was done of 155 consecutive patients with ARF duing 1990 through 1997 （A period） and 267 patients from the 2000 through 2007 （B period）, and comparing with the changes of clinic and prognosis. Results In comparison with patients in the A period, those in the B period had a significantly lower rate of hospital non-survival （33.3% versus 47.7%）, and had a lower incidence of multiple organ failure than that of A period. In the B period, the patients had more chronic problems and more factors contrbuting to the development of ARF, more nephrotoxic matters and more hemodialysis cases.The patients with preexisting lung disease or postsurgical were most common, the occurrence of multiple organ failure, sepsis, postsurgical, preexisting live and lung disease were associated with a dismal prognosis in both study periods. Conclusion The prognosis of patients with ARF has improved in recent years, despite the factors that patients have more preexisting chronic health conditions, and more nephrotoxic matters, the patients have more hemodialysis,the mean age was not changed obviously.