摘要目的 对老年急性肾损伤(AKI)患者进行随访观察,分析AKI的短期预后及危险因素.方法 选择2008年1月-2009年12月就诊于解放军总医院的232例老年AKI患者的病历资料,根据发生AKI后28 d和29 d至3个月时患者的生存情况,将患者病历资料分成死亡组和存活组进行分析,采用t检验或Pearson x2检验筛查出影响预后的因素,将有统计学意义的因素为自变量进行多因素Logistic回归分析,判断各因素对死亡风险的影响.结果 232例老年AKI患者,平均年龄(86.7±5.3)岁.28 d内死亡38例(16.4％),3个月内共死亡57例(24.6％).感染(43.1％)为最常见病因,其次为低血容量(19.0％)、肾毒性药物(16.8％)和心血管事件(15.1％)等.多因素Logistic 回归分析显示低体质指数(BMI)、少尿、机械通气、血清白蛋白降低、血清肌酐(Scr)峰值(＞246.5μmol/L)是影响AKI患者28 d时预后的因素(均P＜0.05)；低BMI、血清白蛋白降低及血尿素氮增高是影响AKI患者29 d至3个月时预后的因素(均P＜0.05).结论 感染、低血容量、肾毒性药物、心血管事件等是诱发AKI最常见的原因；低BMI、少尿、机械通气、血清白蛋白降低、血尿素氮增高、Scr峰值(＞246.5 μmol/L)是影响AKI患者预后的危险因素.

abstractsObjective To explore the risk factors and short-term outcomes of acute kidney injury (AKI) in elderly patients.Methods A total of 232 elderly AKI patients at Chinese PLA General Hospital from June 2008 to December 2009 were enrolled.They were divided into two groups according to their outcomes at 28 days and at 29 days to 3 months after AKI respectively.Their clinical data were analyzed to explore the risk factors and their effects on the outcomes of AKI.Results There were 215 males and 17 females with an average age of (86.7 ± 5.3) years.Thirty-eight cases (16.4％) died within 28 days after AKI and 57 (24.6％) died within 3 months.Infection (43.1％) was the major cause of AKI.The other causes included hypovolemia (19.0％),use of nephrotoxic drugs (16.8％) and cardiovascular events (15.1％) respectively.Logistic regression analysis revealed that low body mass index (BMI),oliguria,mechanical ventilation,hypoalbuminemia and peak serum level of creatinine (Scr ＞ 246.5 μmol/L) were the prognostic factors of AKI in those patients dying within 28 days after AKI (P ＜ 0.05).Low BMI,hypoalbuminemia and high blood level of urea nitrogen (BUN) were the prognostic factors of AKI in those patients dying within 29 days to 3 months after AKI (P ＜ 0.05).Conclusion Infection,hypovolemia,use of nephrotoxic drugs and cardiovascular events are common causes of AKI in elderly patients.Low BMI,oliguria,mechanical ventilation,hypoalbuminemia,high level of BUN and peak level of Scr (＞ 246.5 μmol/L) are the prognostic factors of AKI in elderly patients.