摘要
目的 探讨老年人急性肾功能衰竭 (ARF)的临床特点 ,以期提高老年人ARF的诊治水平。 方法 对 10 9例老年 (≥ 6 0岁 )ARF患者的诊断、治疗及转归进行回顾性分析 ,并与同期收治的175例青年ARF患者 (18～ 4 0岁 )进行比较。 结果 老年ARF患者占同期 4 2 2例ARF患者的2 5 8% ,其住院病死率为 5 8 7%。肾前性ARF、败血症引起的ARF是老年人ARF的主要临床类型 ,分别占 2 0 2 %和 15 6 %。感染 (5 2 3%比 2 9 7% )、心血管合并症 (6 4 2 %比 38 3% )、呼吸衰竭 (43 1%比2 0 0 % )、高钾血症 (2 9 4 %比 15 4 % )等并发症老年ARF患者高于青年患者 (P <0 0 0 1或P <0 0 1)。以发生ARF后 30天为观察终点 ,发现老年ARF患者肾功能恢复较青年组差。透析中低血压 (11 8%比 3 3% )、心绞痛 (10 1%比 1 5 % )、失衡综合征 (5 2 %比 2 1% )等合并症的发生率较青年患者高 (P<0 0 0 1或P <0 0 5 )。 结论 老年ARF患者并存慢性疾病和并发症多是其病死率高的主要原因 ,积极防治基础病 ,及时、正确地处理临床并发症可改善预后。
Objective To elucidate the clinical characteristics and the outcome of acute renal failure (ARF) in the elderly. Methods Clinical data of 109 elderly patients(≥60 years) with ARF were analysed and compared with that of 175 younger adult ARF patients(18 40 years) in the same period. Results 109 out of 422 patients(25 8%) with ARF were more than 60 years. The mortality rate of ARF in these patients was 58 7%. ARF was induced mainly by prerenal factors (20 2%) and sepsis (15 6%). Complications such as infections (52 3% vs 29 7%), cardiovascular events (64 2% vs 38 3%), respiratory failure (43 1% vs 20 0%) and hyperkalemia (29 4% vs 15 4%) were more prevalent in elderly patient than that in the younger adult ARF patients ( P <0 001 and P <0 01). Renal function recovery delayed in elderly patients compared with that in the younger ARF patients. Hypotension(11 8% vs 3 3%), angina (10 1% vs 1 5%) and disequilibrium syndrome(5 2% vs 2 1%) were more often than that in the younger patients ( P <0 001 and P <0 05) when they were on hemodialysis. Conclusions The prevalence of underlying disease and clinical complications in elderly patients might be responsible for the higher mortality in these patients with ARF.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2002年第4期251-253,共3页
Chinese Journal of Geriatrics
基金
总后勤部高新技术重大项目
