ACUTE POSTTRAUMATIC RENAL-FAILURE - A MULTICENTER PERSPECTIVE
ACUTE POSTTRAUMATIC RENAL-FAILURE - A MULTICENTER PERSPECTIVE
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DOI：
10.1097/00005373-199112000-00003
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发表时间：
1991-12-01
影响因子：
--
通讯作者：
BASS, SM
中科院分区：
文献类型：
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作者：
MORRIS, JA;MUCHA, P;BASS, SM
外伤后发生急性肾功能衰竭是罕见的. 历史上，ARF与高死亡率相关。 为了调查这一事实，我们对在9个地区创伤中心接受治疗的72,757例住院患者进行了回顾性分析。 78例患者（0.098%）发生需要血液透析的急性肾功能衰竭。 收集了详细的人口统计学、临床和结局数据。 有既往病史的患者（I组）的死亡率比无既往病史的患者高70%（p < 0.004）。 24名患者（31%）在受伤后不到6天发生ARF（第II组）。 其余患者（第III组）发生晚期肾衰竭（至首次透析的平均时间，23天）。 死亡的主要原因是多器官功能衰竭（82%）。 三组患者因多器官功能衰竭导致的死亡率无差异。 在33名幸存者中，6名（18%）因肾功能不全出院，3名（9%）因透析出院，23名（70%）出院回家或康复，27名（82%）无明显肾功能不全证据。 结论：需要血液透析的创伤后肾衰竭很少见（发病率为107/100，000创伤中心入院），但死亡率仍然很高（57%）。 三分之二的创伤后肾功能衰竭病例发展较晚，继发于多器官衰竭;三分之一的创伤后肾功能衰竭病例发展较早，可能是复苏不充分所致。
Acute renal failure (ARF) following trauma is rare. Historically, ARF has been associated with a high mortality rate. To investigate this entity we conducted a retrospective review of 72,757 admissions treated at nine regional trauma centers over a 5-year period. Seventy-eight patients (0.098%) developed acute renal failure requiring hemodialysis. Detailed demographic, clinical, and outcome data were collected. Patients with pre-existing medical conditions (group I) had a 70% increase in mortality over those without pre-existing conditions (p < 0.004). Twenty-four patients (31%) developed ARF less than 6 days after injury (group II). The remainder (group III) developed late renal failure (mean time to first dialysis, 23 days). The predominant cause of death was multiple organ failure (82%). There were no differences in mortality because of multiple organ failure among the three groups of patients. Of the 33 survivors, six (18%) were discharged with renal insufficiency, three (9%) were discharged on dialysis, 23 (70%) were discharged home or to rehabilitation, and 27 (82%) had no significant evidence of renal insufficiency. Conclusion: Posttraumatic renal failure requiring hemodialysis is rare (incidence, 107 per 100,000 trauma center admissions), but the mortality rate remains high (57%). Two thirds of the cases of posttraumatic renal failure develop late and are secondary to multiple organ failure; one third of the cases of posttraumatic renal failure develop early and may result from inadequate resuscitation.