Qutub H O, Saeed I A
Department, of Internal Medicine, King Fahd Hospital of the University, Al Khobar 31952, Kingdom of Saudi Arabia.
Saudi Med J. 2001 Nov;22(11):999-1003.
To determine the clincal course and outcome of acute renal failure in an intensive care unit set-up.
All patients admitted to the intensive care until who developed acute renal failure were prospectively studied over a 3-year period from 1996 to 1999, at King Fahd Hospital of the University, Al Khobar, Kingdom of Saudi Arabia. They were investigated for the causes of their acute renal failure, given appropriate treatment and their course carefully documented until discharge from the intensive care unit.
Forty-seven patients (29 male and 18 female) were studied. The majority were Saudis (81%). The age range was 28-81 years with a mean of 53 +/- 14 years. Renal causes, 31 cases (66%), were the most frequent causes of acute renal failure. Pre-renal causes occurred in 12 cases (25.5%) and post-renal causes in 4 cases (8.5%). Three quarters of the causes were medical and one quarter surgical. Septicemia (22 cases), dehydration with hypovolemia (8 cases) and myo/hemoglobinuria (5 cases) were the leading medical causes. Fifteen patients (32%) died in the intensive care unit while 32 were discharged (68%). Multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus were the major factors that adversely affected mortality. There was a statistically significant difference in the length of intensive care unit stay of the survivors (5.7+/-2.6 days) compared to the deceased (11+/-5.8 days) (P<0.005). Renal replacement therapy was performed in 15 patients (10 continuous veno-venous hemodialysis and 5 conventional hemodialysis). Almost 3 quarters (73%) of the deceased required renal replacement therapy.
The development of acute renal failure in the setting of an intensive care unit carried a poor prognosis. Renal causes are responsible for 2 in 3 cases. Septicemia, dehydration/hypovolemia, myo/hemoglobinuria are the leading medical causes while multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus increase mortality. The poor prognosis of patients developing acute renal failure in the intensive care unit can be improved if attention is paid to prevention of septicemia, dehydration, prompt and aggressive treatment of multiple organ dysfunction, disseminated intravascular coagulopathy, acute respiratory distress syndrome and diabetes mellitus.
确定重症监护病房中急性肾衰竭的临床病程及转归。
1996年至1999年期间，在沙特阿拉伯王国胡拜尔市法赫德国王大学医院，对所有入住重症监护病房并发生急性肾衰竭的患者进行了为期3年的前瞻性研究。对他们的急性肾衰竭病因进行了调查，给予适当治疗，并仔细记录其病程直至从重症监护病房出院。
共研究了47例患者（29例男性和18例女性）。大多数为沙特人（81%）。年龄范围为28 - 81岁，平均年龄为53±14岁。肾性病因31例（66%），是急性肾衰竭最常见的病因。肾前性病因12例（25.5%），肾后性病因4例（8.5%）。四分之三的病因是内科性的，四分之一是外科性的。败血症（22例）、伴有低血容量的脱水（8例）和肌红蛋白尿/血红蛋白尿（5例）是主要的内科病因。15例患者（32%）在重症监护病房死亡，32例出院（68%）。多器官功能障碍、弥散性血管内凝血、急性呼吸窘迫综合征和糖尿病是影响死亡率的主要因素。存活患者在重症监护病房的住院时间（5.7±2.6天）与死亡患者（11±5.8天）相比，差异有统计学意义（P<0.005）。15例患者接受了肾脏替代治疗（10例连续性静脉 - 静脉血液透析和5例常规血液透析）。近四分之三（73%）的死亡患者需要肾脏替代治疗。
重症监护病房中急性肾衰竭的预后较差。三分之二的病例由肾性病因引起。败血症、脱水/低血容量、肌红蛋白尿/血红蛋白尿是主要的内科病因，而多器官功能障碍、弥散性血管内凝血、急性呼吸窘迫综合征和糖尿病会增加死亡率。如果重视败血症、脱水的预防，以及对多器官功能障碍、弥散性血管内凝血、急性呼吸窘迫综合征和糖尿病进行及时、积极的治疗，重症监护病房中发生急性肾衰竭患者的不良预后可以得到改善。
