急性肾功能衰竭344例的病因及死因分析

本文将我院1963年至1983年所收治的344例急性肾功能衰竭患者的病因及死因进行分析。病例选择系按全国危重病急救医学学术会议拟定的标准进行。但本组包括肾前及肾后病因在内。344例中肾前性7例(2%),死亡5例,病死率为71.43%;肾性331例(96.2%),死亡60例,病死率为18.1%;肾后性5例(1.5％),原因不明者1例(0.3%),后二者无死亡。引起急性肾功能衰竭的原发病以流行性出血热居首位(占68.9%),与全国危重病急救医学学术会议报告一致,但百分率却高于前者,此与嘉陵江流域系黑线姬鼠的自然分布区有关。鱼苦胆中毒居次位,共53例(15.4%)。败血症等感染居第三位共23例(6.7%),但为本组的主要死因之一。本文着重讨论了败血症等感染性休克时引致急性肾功能衰竭的发生机理和近代观点,并总结经验教训。本组结果显示死亡病例中大多数死于少尿期,故强调早期透析和预防性透析对改善预后和降低死亡率的重要意义。如无血透条件则腹膜透析操作易于掌握、安全有效,无绝对禁忌症,值得推广。

THE ETIOLOGY AND CAUSE OF DEATH IN A.R.F --(ANALYSIS IN 344 PATIENTS

The aim of this study was to investigate the etiology and the cause of death in A. R. F. restrospectively. 344 patients being hospitalized in the first teaching hospital of Chongqing Medical College between 1963 and 1983 were selected. Three categories sre classified in this group. There are 7 cases in the pre-renal failure (2%) in which five died, the fatality rate was 71.43%. 331 cases in the renal failure (18.1) (96.2%), in which 60 died, the fatality rate was 71.4%, 5 cases in the post-renal failure(18.1%) and one case is unknown,no death in the last two.The result showed that Epidemic haemorrhagic fever inducing A. R. F. is put in the first place. Fish gall bladder poisoning is put in the second place. Septicemia is put in the third place, but it is the main death cause in this study.This paper mainly discusses the pathogenesis as well as recent viewpoints and summarizes the experience of the treatment of Septicemia. It also emphasizes the early dialysis and prophylactic dialysis which can improve the prognosis and decrease the mortality rate.