摘要
目的总结高原脑水肿并发急性肾功能衰竭(ARF)的病因、临床特点以及影响预后的因素。方法回顾分析西藏军区总医院1999-01～2005-12收治的高原脑水肿并发ARF患者的临床资料。结果共收治高原脑水肿并发ARF患者58例,其中社区获得性ARF 18例,占31．0%；医院获得性ARF40例,占69．0%。肾前性ARF 25例,占43．1%,其中以高原脑水肿自身导致的肾脏低灌注最常见,为15例。肾性ARF 33例,占56．9%,其中药物引起2l例,占肾性ARF的63．6%。患者总病死率为34．5%,医院获得性ARF病死率(45．0%)明显高于社区获得性ARF(11．1%,P＜0．05)。单因素分析显示,年龄、肾脏病史、少尿或无尿、血红蛋白和器官衰竭数是影响预后的因素。多因素Logistic回归分析显示,器官衰竭数和血红蛋白是影响病死率的因素。结论高原脑水肿并发的ARF主要为医院获得性,甘露醇导致的肾损害需要特别关注；预防多脏器功能不全综合征的发生是降低病死率的关键。
Objective To analyze the etiologies, clinical characteristics and prognostic factors of the patients with high altitude cerebral edema（ HACA） combined with acute renal failure（ ARF） in hospital. Methods This retrospective study included clinical data of the patients with HACA combined with ARF in the General Hospital of Tibet Military Command from January 1999 to December 2005. Results There were 35 males and 23 females with mean age （40.4 ±13.0） years old. Among the 58 cases, 69.0% was hospital acquired ARF（ HA - ARF） showed an increasing trend year by year. The patients of ARF included pre - renal ARF（ 25, 43.1%） , renal parenchymal ARF（33, 56.9%）. Hypoperfusion of kidney caused by high altitude cerebral edema （ 15） was major cause of pre -renal ARF. Among the 33 cases of renal parenchymal ARF, 18 were induced by mannitol. The total mortality of the patients in our study was 34.5%. The mortality （45.0%） of HA - ARF patients was much higher than that （ 11.1%） of community acquired ARF （ CA - ARF） （ P 〈 0.05）. There were no significant differences in the mortality between the patients with and without dialysis treatment. Univariate analysis showed that the prognosis correlated with age, history of renal disease, the presence of oliguria or anuria, hemoglobin（ Hb） and the number of organ failures. The Logistic regression showed that Hb and the number of organ failures were the predictors of mortality. Conclusion The majority of HACA combined with ARF were hospital acquired. Attention must be paid to the lesion caused by mannitol. The prevention of MODS is a key way to decrease mortality in HACA combined with ARF.
出处
《中国急救医学》
CAS
CSCD
北大核心
2006年第12期885-887,共3页
Chinese Journal of Critical Care Medicine
关键词
高原
脑水肿
急性肾功能衰竭
病因学
预后
High altitude
Cerebral edema
Acute renal failure
Etiology
Prognosis
