不同持续时间老年急性肾损伤患者的临床特征观察

Clinical Characteristics of Acute Kidney Injury of Different Duration in the Elderly

目的观察老年急性肾损伤(AKI)患者不同持续时间的临床特征。方法按照AKI不同持续时间将无锡市第二人民医院120例老年AKI患者分为3组:Ⅰ期组(n=35)、Ⅱ期组(n=49)和Ⅲ期组(n=36),定期检测各组患者尿量,对患者不同病因分别采取去除病因、维持内环境稳定、营养支持和血液净化治疗。评估并比较3组的住院天数、完全治愈率、病死率、器官衰竭率、治疗方式、机械通气率、急性生理学与慢性健康状态评分(APACHEⅡ)、序惯性器官衰竭评估(SOFA)、急性肾小管坏死个体病情严重性指数(ATN-ISI)、平均动脉压(MAP)、血清钾离子(K+)浓度、血清pH值、氧和指数(PaO2/FiO2)、HCO3浓度、尿量(UV)及并发症发生率等,并对3组出院后肾功能恢复情况进行比较。结果Ⅲ期组在住院天数、器官衰竭在3个以上比例、肾脏替代治疗比例、APACHEⅡ评分、SOFA评分以及ATN-ISI评分上都明显高于Ⅰ期组和Ⅱ期组,而完全治愈率明显低于Ⅰ期组和Ⅱ期组(P<0.05)。治疗前,Ⅲ期组MAP、K+浓度显著高于Ⅰ期组,UV、pH值、PaO2/FiO2和HCO3均显著低于Ⅰ期组和Ⅱ期组(P<0.05);治疗后,Ⅲ期组UV显著低于Ⅰ期组和Ⅱ期组(P<0.05)。Ⅲ期组并发症总发生率(77.78%)显著高于Ⅰ期组(51.43%)和Ⅱ期组(55.10%)(P<0.05)。Ⅲ期组肾功能恢复率(27.78%)显著低于Ⅰ期组(80.00%)和Ⅱ期组(63.27%)(P<0.05);Ⅲ期组继续血液净化治疗率(41.67%)显著高于Ⅰ期组(2.86%)和Ⅱ期组(2.04%)(P<0.05)。结论老年AKI在Ⅰ期、Ⅱ期治疗中有较Ⅲ期治疗更高的临床治愈率,且患者较为耐受,老年AKI患者应在Ⅰ期及时就诊。

Objective To observe the clinical characteristics of acute kidney injury(AKI) of different duration in the elderly.Methods 120 elderly with AKI were divided,according to the duration of AKI,into 3 groups:stage Ⅰ group(n=35),stage Ⅱ group(n=49) and stage Ⅲ group(n=36);regular measurement of urine volume(UV) was made to the elderly in each group and different treatments including eliminating the cause of disease,maintaining internal environment stability,nutritional support and blood purification were provided to the elderly with different causes of disease;hospitalization days,complete cure rate,mortality,organ failure rate,treatment mode,mechanical ventilation rate,acute physiology and chronic health status score(APACHE Ⅱ) scores,sequential inertial organ failure assessment(SOFA) scores,individual severity index of acute tubular necrosis(ATN-ISI),mean arterial pressure(MAP),serum potassium concentration,serum pH value,oxygen and index(PaO2/FiO2),HCO3 concentration,UV and the incidence of complications were observed and a comparative study was made among the 3 groups,and the recovery of renal function of the elderly after discharge was comparatively studied as well.Results The hospitalization duration,the proportion of the cases with more than 3 organ failures and with renal replacement therapy,the SOFA scores and ATN-ISI scores in stage Ⅲ group were longer and higher than those in stage Ⅰ group and stage Ⅱ group;before treatment,the MAP and serum potassium concentration were obviously higher in stage Ⅲ group than those in stage Ⅰ group while the UV,serum pH value and Pa02/Fi02 index in stage Ⅲ group were significantly smaller and lower than those in stage Ⅰgroup and stage Ⅱ group(P<0.05) while after treatment,the UV in stage Ⅲ group was much smaller than that in stage Ⅰ group and in stage Ⅱ group(P<0.05);the total occurrence of complication in stage Ⅲ group(77.78%) was higher than that in stage Ⅰgroup(51.43%) and that in stage Ⅱ group(55.10%)(P<0.05);the rate of renal function recovery in stage Ⅲ group(27.78%)was significantly lower than that in stage I group(80.00%) and that in stage Ⅱ group 63.27%)(P<0.05);the rate of continuous blood purification in stage Ⅲ group(41.67%) was greatly higher than that in stage Ⅰ group(2.86%) and that in stage Ⅱ group(2.04%)(P<0.05).Conclusions The elderly with AKI are of better tolerance to the treatment and may gain a higher clinical cure rate at stage Ⅰ and stage Ⅱ than at stage Ⅲ,thus they should go for in-time treatment at stage Ⅰ.