老年慢性肾功能不全急剧恶化原因及防治措施

Causes and Preventive Measures of Sharp Deterioration of Chronic Senile Kidney Function Deficiency

目的:分析老年慢性肾功能不全的原发病因,及其导致肾功能急剧减退的因素,探讨预防抢救措施。方法:研究对象为31例原有慢性肾功能不全的老年患者,年龄均在60岁以上,并在短期内出现急性肾功能不全,肾功能评价为血Cr值。结果:老年慢性肾功能不全的原发病因依次为高血压肾病、糖尿病肾病、梗阻性肾病和动脉硬化性肾病。导致急剧恶化的因素为:不同原因所致的脱水、水电解质失衡7例(22.5％),心衰、低血压8例(25.8％),各种感染6例(19.3％),血压增高4例(12.9％),血糖增高3例(9.7％),急性尿潴留3例(9.7％)等。结论:任何诱发因素都可以使老年慢性肾功能不全急剧恶化。抢救原则除维持水电解质平衡与酸碱平衡、控制氮质血症、加强营养支持、积极控制各种并发症之外,严格控制原发病,认真寻找并治疗可逆因素,积极寻找病因和诱因并予以去除,以及病因治疗个体化等,是延缓老年慢性肾功能不全的进展和防止急性肾功能减退的重要措施。

Objective: Analyze the primary pathogeny of chronic senile kidney function deficiency, factors that sharply degenerate the function of kidney, and probe preventive and salvage measures. Method: The research objects are 31 aged patients who suffer from the chronic kidney function deficiency, and all of them are above 60. They have the symptom of acute functional disorder of kidney in a short period. The kidney function is appraised as blood cr. Result: The primary. pathogeny of chronic senile kidney function deficiency take this turns: hypertension nephropathy, diabetes nephropathy, obstruction nephropathy, arteriosclerosis nephropathy. The factors that lead to sharp deterioration are: dehydration owing to different reasons, 7cases of hydro-electrolyte unbalance (22.5%), heart failure, 8 cases of low blood pressure (25.8%), 6 cases of various infections (19. 3% ), 4 cases of heightened blood pressure (12.9%), 3 cases of increased blood sugar (9.7%), 3cases of acute urosehesis (9.7%) and so on. Conclusion: Any inducement may lead chronic senile kidney function deficiency to rapid deterioration. Hence we must maintain the balance of electrolyte and that between acid and alkali, control proteinemia, strengthen nourishment support, control other syndrome actively. Besides that, searching reversible factor, controlling the primary affection, searching and eliminating the inducement are the important measures to retard the evolvement of the disease and to prevent acute kidney functional degeneration.