上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

老老年患者急性肾损伤的特点和血液净化治疗评价

司徒碧颖，颜佳琳，孙建设，叶志斌   

  1. 复旦大学附属华东医院肾内科  上海市老年病学研究所， 上海200040
  • 出版日期:2015-09-28 发布日期:2015-09-30
  • 通讯作者: 叶志斌, 电子信箱: yezb2013@163.com。
  • 作者简介:司徒碧颖（1968—）, 女, 副主任医师， 硕士; 电子信箱: situbiying@126.com。

Characteristics of acute kidney injury of senile patients and evaluation of blood purification treatment

SITU Bi-ying, YAN Jia-lin, SUN Jian-she, YE Zhi-bin   

  1. Shanghai Key Laboratory of Clinical Geriatric Medicine,Department of Nephrology, Huadong Hospital, Fudan University， Shanghai 200040, China
  • Online:2015-09-28 Published:2015-09-30

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摘要：

目的  探讨老老年急性肾损伤的特点和治疗方法。方法  对2009年1月—2014年12月收治的150例急性肾损伤病例进行回顾性分析。所有病例均符合KDIGO急性肾损伤的诊断标准。比较两个年龄层（≥80岁和＜60岁）患者的伴随疾病、疾病严重程度以及60 d病死率，监测不同的血液净化治疗前后生化指标和患者血压波动情况，并分析两组的死亡危险因素。结果  150例患者中，≥80岁(老老年组)91例，平均年龄（88.6±5.0）岁;＜60岁(成年组)59例，平均年龄（44.3±12.6）岁。老老年组的主要伴随疾病依次为原发性高血压、冠状动脉硬化性心脏病（冠心病）和糖尿病等，成年组则为急慢性肾炎、恶性肿瘤、系统性自身免疫疾病和梗阻性肾病，另有27.1%的成年组患者无任何伴随疾病。老老年组病情较成年组严重，急性生理与慢性健康评分（APACHEⅢ评分）、机械通气比例及脓毒血症、低血压和多器官功能障碍综合征（MODS）比例显著高于成年组（P<0.001）。老老年组94.5%选择每日床边缓慢低效血液透析滤过疗法，成年组93.2%接受间歇血液透析治疗。治疗前两组收缩压和舒张压的差异有统计学意义，但经过血液净化治疗后，两组间收缩压和舒张压的差异无统计学意义；组内治疗前后血清肌酐和HCO3-有显著差异。老老年组60 d病死率为65.9%，显著高于成年组的30.5%（P<0.01）。两组的综合死亡危险因素依次为APPECHⅢ评分、MODS和年龄。结论  老老年急性肾损伤患者由于肾功能下降，伴随疾病多，病情比成年患者严重，病死率更高。综合治疗更适合有并发症、血液动力学指标不稳定的老老年患者。

关键词: 急性肾损伤, 老老年患者, 每日床边缓慢低效血液透析滤过疗法, 血液透析

Abstract:

Objective  To investigate the characteristics and treatment of acute kidney injury (AKI) of senile patients. Methods  A total of 150 cases of AKI treated from January 2009 to December 2014 were retrospectively analyzed. All cases accorded with the diagnosis criteria of AKI of KDIGO. Accompanied diseases, severity of diseases, and 60-day fatality rate of patients older than 80 years and younger than 60 years were compared. Biochemical indexes and blood pressure of patients before and after blood purification were monitored and risk factors of mortality of two groups were analyzed. Results  Among 150 patients, 91 of them were older than 80 years (senile group) with average age of (88.6±5.0) years and 59 of them were younger than 60 years (adult group) with average age of (44.3±12.6) years. Accompanied diseases of the senile group were primary hypertension, coronary heart disease, and diabetes mellitus, while those of the adult group were acute or chronic nephritis, malignant tumor, systemic autoimmunity disease, and obstructive nephropathy. And 27.1% of patients of the adult group did not have any accompanied diseases. Diseases of the senile group were severer than those of the adult group. APACHE Ⅲ scores, rate of medical ventilation, and the incidence of sepsis, hypotension, and MODS of the senile group were significantly higher than those of the adult group (P<0.001). In the senile group, 94.5% of patients underwent bedside slow low-efficiency daily dialfiltration (SLEDD-f) therapy, while 93.2% of patients of the adult group accepted intermediate hemodialysis (IHD). The differences of systolic and diastolic pressures between two groups before treatment were statistically significant, but after blood purification, the differences between two groups were not statistically significant. The serum creatinine and HCO3- levels within the group before and after treatment were significantly different. The 60-day fatality rate of the senile group was 65.9%, which was significantly higher than that of the adult group (30.5%, P＜0.01). The risk factors of mortality of two groups were APPECH Ⅲ scores, MODS, and age. Conclusion  Diseases of senile patients with AKI were severer than those of the adult patients and the fatality rate of senile patients was higher due to decreased renal function and more accompanied diseases. Comprehensive treatment is more suitable for senile patients with complications and unstable hemodynamic indexes.

Key words: acute kidney injury, senile patients, bedside slow low-efficiency daily dialfiltration, hemodialysis