摘要
目的对重症医学科(ICU)老年危重病患者应用急性肾损伤(AKI)诊断分期标准监测肾功能的变化并指导治疗,以期改善预后。方法 2007年8月至2008年8月收住ICU的老年危重病患者134例为对照组,2008年9月年2009年9月收住ICU的老年危重病患者170例为实验组。实验组引入AKI诊断分期标准监测肾功能的变化并指导治疗,其它支持治疗原则与对照组相同。记录两组患者ICU期间医院获得性急性肾损伤(HA-AKI)的发生及血液净化的应用状况,比较预后。结果对照组HA-AKI发病率、AKI 3期占HA-AKI比例、ICU住院时间、病死率分别是37.3%,34.0%,(10.2±3.2)d和40.3%,实验组分别为26.5%,15.6%,(8.2±2.8)d和26.5%,两者差异有统计学意义(P<0.05)。实验组未发生HA-AKI患者125例,HA-AKI 1期9例、2期29例、3期7例,病死率分别是16.8%,33.3%,51.7%和85.7%,差异有统计学意义(P<0.05);未发生HA-AKI的患者与HA-AKI 1期、2期患者ICU住院时间分别为(7.3±2.3),(10.4±3.2)和(13.2±3.7)d,差异有统计学意义(P<0.05)。对照组HA-AKI患者行血液净化20例,占HA-AKI患者的40.0%,住院时间(8±3)d,病死率72.0%;实验组HA-AKI患者行血液净化29例,占HA-AKI患者的64.4%,住院时间(11±3)d,病死率51.1%,两组之间差异有统计学意义(P<0.05)。结论 AKI诊断分期标准对老年危重病患者很重要,可以减少HA-AKI及AKI 3期的发生率。HA-AKI的发生及进展使预后恶化,早期血液净化治疗能改善老年HA-AKI患者的预后。
Objective To investigate whether the prognosis of the critically ill elderly patients can be improved by using the standards for definition and classification of acute kidney injury（AKI） for monitoring the changes of renal function and guiding the therapy. Methods Totally 134 critically ill elderly patients admitted to ICU from August 2007 to August 2008 were assigned to the control group,and 170 critically ill elderly patients from September 2008 to September 2009 to the experimental group.The standards for definition and classification of AKI was used to monitor the changes of renal function and guide the therapy in the experimental group.The other treatment principles were identical between the two groups.The incidence of hospital acquired-AKI（HA-AKI） and the application of blood purification were recorded,and the patients＇ outcomes were compared between the two groups.Results The incidence of HA-AKI,proportion of HA-AKI stage 3,length of stay in ICU and mortality were 37.31%,34.00%,（10.2±3.2） days and 40.30%respectively in control group,and were 26.47%,15.56%,（8.2±2.8） days and 26.47%respectively in experimental group.There were significanct differences between the two groups（P0.05）.In experimental group,there were 125 cases without HA-AKI,9 cases with HA-AKI stage 1,29 cases with HA-AKI stage 2 and 7 cases with HA-AKI stage 3.Their mortalities were 16.8%,33.3%,51.7%and 85.7%respectively,with significanct differences（P0.05）.The length of stay in ICU were（7.3±2.3）,（10.4±3.2）,（13.2±3.7） days respectively in the patients without HA-AKI,with HA-AKI stage 1 and HA-AKI stage 2,with significanct differences（P0.05）.Among patients with HA-AKI in control group,20 received blood purification,accounting for 40%;the length of stay in ICU was（8±3） days; the mortality was 72.0%.However,among patients with HA-AKI in control group,29 received blood purification,accounting for 64.4%; the length of stay in ICU was（11±3） days;the mortality was 51.1%.There were significant differences between the two groups（P0.05）.Conclusion The standards for definition and classification of AKI is of great significance for critically ill elderly patients.It can decrease the incidences of HA-AKI and the proportion of AKI stage 3.HA-AKI can deteriorate the patient＇s prognosis.We recommend early blood purification therapy for the elderly patients with HA-AKI.
出处
《中华老年多器官疾病杂志》
2011年第3期229-232,共4页
Chinese Journal of Multiple Organ Diseases in the Elderly
关键词
老年人
危重病
肾功能不全
急性
肾透析
elderly
critically ill
kidney insufficiencies
acute
renal dialysis
