急性肾功能衰竭病因及预后分析

The causes and prognosis of patients with acute renal failure

目的探讨急性肾功能衰竭(ARF)的病因和预后因素。方法回顾性总结115例ARF的临床资料,其中老年组40例,非老年组75例,对比分析两组患者的病因及预后。结果两组ARF病因明显不同:①老年组肾前性因素以大量失液或严重摄入不足(57.5%)、感染(42.5%)为主,非老年组则以创伤(65.0%)、感染(20.0%)为主;②老年组肾性因素以药物中毒(60.0%)、生物中毒(25.0%)为主,非老年组多见于急性肾脏疾病(65.3%)、生物中毒(13.3%);③老年组肾后性(12.5%)显著高于非老年组(4.1%)。④老年组原发慢性病(90.0%)及多器官障碍综合征(37.5%)高于非老年组(分别为16.0%、5.3%);⑤老年组病死率为57.5%显著高于非老年组的13.3%(P<0.01)。影响老年组ARF预后因素主要是MODS及原发慢性病。结论积极防治MODS和原发慢性病,是降低老年ARF发病率和病死率的关键措施。

Objective To investigate the etiology and prognosis of patients with acute renal failure（ARF）. Methods The etiology and prognosis of patients with ARF（40 elderly and 75 young） were analyzed retrospectively. Results The causes of the two groups were different significantly. （1）The main causes of pre-renal ARF in the elderly were deficient of effective blood volume （57.5%）,infection （42.5%）. The main causes in the young was wound （65%） ,infection（20% ）. （2）The causes of renal ARF in the elderly were drug toxication（60% ） and biology toxication（25% ）. But causes in the young were acute kidney disease（65.3% ） and biologic toxication （ 13.3% ） ;（3）The patients with post-renal ARF in the elderly（ 12.5% ） were significantly higher than the young（4. 1% ）. （4）Original diseases（90% ）and multiple organ dysfunction syndrome （MODS） （37.5%）in the elderly were higher than those of the young（ 16% ,5.3% respectively）. （5）The mortality in the elderly（57.5% ）was significantly higher than that in the young（ 13.3% ） （P 〈0. 01 ）. Conclusions The prevention and manegment of MODS and primary diseases are important to reduce the morbidity and mortality of the elderly with ARF.