本文關(guān)鍵詞：急性腦卒中患者并發(fā)急性腎功能衰竭的臨床特點回顧性分析，由筆耕文化傳播整理發(fā)布。

        目的急性腦卒中以高發(fā)病率、高致死率和高致殘率,與心臟病、惡性腫瘤共同構(gòu)成了人類的三大疾病死因。急性腦卒中患者多為老年患者,有高血壓、糖尿病、冠心病等病史,發(fā)病后意識障礙、進食量不足、應(yīng)用大量脫水劑等因素均可導(dǎo)致急性腎衰竭(ARF)的發(fā)生,ARF已成為急性腦卒中的嚴重并發(fā)癥之一。然而ARF的預(yù)后并不理想,盡管監(jiān)護手段和腎臟替代治療有了長足進步,但ARF的預(yù)后仍然不盡人意。ARF的發(fā)生增加了腦卒中的治療難度和病死率,但若提早預(yù)防,及時糾正,合理治療,則對疾病的良性轉(zhuǎn)歸起很大作用。本文旨在探究急性腦卒中住院患者并發(fā)ARF的發(fā)病原因,臨床特點,治療及預(yù)后情況等,為預(yù)防和治療急性腦卒中患者并發(fā)ARF提供臨床參考資料。方法1.選取2005年1月至2012年6月山東大學(xué)附屬省立醫(yī)院神經(jīng)內(nèi)科收治住院的確診為腦卒中患者為統(tǒng)計對象,包括缺血性腦卒中和出血性腦卒中，共5218例。2.依據(jù)急性腎功能衰竭(ARF)診斷標準,從以上腦卒中患者中,篩選符合標準者207例,從剩余5011例非急性腎功能衰竭患者中篩選2012年1月至2012年5月期間219例作為對照組。3.收集整理納入本研究的所有病例的臨床資料,包括：(1)一般資料、(2)現(xiàn)病史、(3)既往史、(4)并發(fā)癥、(5)腎功能衰竭危險因索及腎功能衰竭臨床癥狀和體征、(6)影像學(xué)檢查及輔助檢查結(jié)果、(7)治療措施、轉(zhuǎn)歸等;進行回顧性研究,分析其臨床特點。4.所有數(shù)據(jù)統(tǒng)計分析均采用SPSS18.0版統(tǒng)計軟件包進行,兩組間計量資料采用1檢驗；兩組間計數(shù)資料采用卡方檢驗；P<0.05有統(tǒng)計學(xué)意義。結(jié)果1.本研究ARF患者中,平均年齡為(72.3±10.3)歲,其中65-75歲和80-85歲是發(fā)病的兩個高峰。卒中后患ARF與未患ARF者在年齡上有顯著差異性(P<0.05)。2.本研究中腦卒中患者病例總數(shù)為5218例,符合ARF診斷標準者為207例。其中卒中后患ARF者中男92例(44.44%),女115例(55.56%)；卒中后未患ARF者中男2509例(50.07%),女2502例(49.93%)。腦卒中患者是否發(fā)生卒中后ARF與其性別無顯著差異性(P>0.05)。3.缺血性腦卒中病例數(shù)為4514例,出血性腦卒中病例為704例。其中缺血性腦卒中發(fā)生卒中后ARF患者171例,出血性腦卒中發(fā)生卒中后ARF患者36例。不同類型的腦卒中患者所致卒中后ARF的發(fā)病率具有顯著性差異(P<0.05)。4.不同卒中類型的卒中后ARF患者,其卒中部位無顯著性差異。不同類型的腦卒中后ARF患者病變部位與皮層的關(guān)系有顯著性差異(P<0.05)。不同卒中類型ARF患者與其血供出現(xiàn)障礙部位無顯著相關(guān)性(P>0.05)。腔隙性腦梗塞后并發(fā)ARF患者為26例(12.56%)；動脈粥樣硬化性腦梗塞并發(fā)ARF患者為55(26.57%)。5.ARF患者既往史有高血壓病者為131例(63.29%),ARF患者既往有糖尿病患者有57例(27.54%),卒中后ARF患者與對照組患者有顯著差異性。不同卒中類型患者有顯著差異性(P<0.05)。ARF患者既往出現(xiàn)TIA、腦卒中病史者17例(8.21%),冠心病病史者有58例(28.02%),ARF患者既往有心房纖顫者為53(25.60%),卒中后ARF患者與對照組患者無顯著差異性。不同卒中類型患者無顯著性差異(P>0.05)。ARF患者既往吸煙者為57例(27.54%),ARF患者既往飲酒為33例(15.95%),卒中后ARF患者與對照組患者無顯著差異性(P>0.05)。不同卒中類型吸煙比率有顯著性差異(P<0.05)。不同卒中類型患者飲酒比率無顯著性差異(P>0.05)。6.卒中后ARF患者多為意識清醒者,意識障礙發(fā)生率為40.58%,缺血性腦卒中患者較易出現(xiàn)嗜睡。出血性腦卒中患者意識障礙程度較為嚴重,較易出現(xiàn)昏睡、昏迷。7.出血性腦卒中患者血壓(SBP.DBP)明顯高于缺血性腦卒中患者(P<0.05)。腦卒中后ARF患者甘油三酯平均值為(1.47±0.53)mmol/L,腦卒中后ARF患者總膽固醇平均值為(5.66±2.35)mmol/L,卒中后ARF患者與對照組患者無明顯差異性,出血性腦卒中患者與缺血性腦卒中患者無明顯差異性(P>0.05)。腦卒中后ARF患者血糖平均值為(8.34±3.24)mg/dl,缺血性腦卒中患者血糖平均水平明顯高于出血性腦卒中患者(P<0.05)。腦卒中后ARF患者BUN變化范圍為(13.85±5.33)mmol/L,腦卒中后ARF患者SCr平均值為(163.3±28.91)umol/L,腦卒中后ARF患者BUN/Cr平均值為(113.5±38.64),腦卒中后ARF患者尿比重平均值為(1.02±0.005),腦卒中后ARF患者尿蛋白平均值為(0.54±0.22)g,出血性腦卒中患者與缺血性腦卒中患者無明顯差異性(P>0.05)。腦卒中后ARF患者滲透壓平均值為(298.2±20.41)mOsm/L,出血性腦卒中患者滲透壓明顯高于缺血性腦卒中患者(P<0.05)。腦卒中后ARF患者血鈣平均值為(2.23±0.62)mmol/L,腦卒中后ARF患者血鉀平均值為(3.89±0.81)mmol/L,腦卒中后ARF患者血鈉平均值為(142.1±5.92)mmol/L,腦卒中后ARF患者血氯平均值為(101.4±2.71)mmol/L。不同卒中類型其電解質(zhì)水平的改變有明顯差異性(P<0.05)。8.從發(fā)病第1天到出現(xiàn)ARF患者應(yīng)用20%甘露醇的總量為(358.5±72.36)g,出血.性腦卒中患者甘露醇用量明顯高于缺血性腦卒中患者(P<0.05)。住院期間卒中后腎功能衰竭患者導(dǎo)尿總?cè)藬?shù)為39例(18.85%),ARF出現(xiàn)后前5天每日液體入、出總量為(3288±725.4)ml/d、(2924±691.1)ml/d,缺血性和出血性患者無明顯差異性(P>0.05)。9.腦卒中并發(fā)ARF患者發(fā)病后30天內(nèi)死亡人數(shù)為75例(36.23%),明顯高于腦卒中對照組患者(P<0.05)。腦卒中并發(fā)ARF患者發(fā)病后好轉(zhuǎn)人數(shù)為111例(53.62%),明顯低于對照組患者好轉(zhuǎn)比率(P<0.05)。缺血性和出血性患者30天內(nèi)死亡率無明顯差異性(P>0.05)。結(jié)論：目前研究發(fā)現(xiàn)急性腦卒中患者并發(fā)ARF的主要因素及臨床特點如下：1)年齡因素。2)高血壓病、糖尿病是ARF發(fā)展的危險因素之一。3)出血性腦卒中較缺血性腦卒中更容易發(fā)生ARF。4)出血性腦卒中皮層下病變?nèi)菀渍T發(fā)腎臟損傷。5)意識障礙的患者容易出現(xiàn)腎臟灌注不足,誘發(fā)ARF。6)甘露醇的過度使用以促使ARF的發(fā)生,出現(xiàn)水電解質(zhì)平衡紊亂。7)ARF的發(fā)生增加腦卒中的死亡風(fēng)險。

    Objective:Stroke is a common disease in neurology department,morbidity, mortality and disability rate are high, as cerebrovascular disease and heart disease, malignant tumor form the top three leading causes of death in humans. Acute stroke patients, mostly consisting of elderly patients with a history of hypertension, diabetes, coronary heart disease.After onset,suffer from a large number of complications,such as disturbance of consciousness, lack of food intake, the application of dehydration,etc, all of which lead to the occurrence of acute renal failure (ARF), while ARF has become one of the most serious complications of acute stroke. However, the prognosis of ARF is not ideal.Though guardianship means and renal replacement therapy have made great progress, the prognosis of ARF is still far from satisfactory. The occurrence of ARF adds to the difficulty of treatment and mortality of stroke, but early prevention,prompt correction,and proper treatment can play a significant role in the positive outcome of the disease. My article aims at exploring the causes of hospitalized acute stroke patients with ARF, clinical features, treatment and prognosis, offering clinical reference for the treatment and prevention of acute stroke patients with ARF.Methods and materials:1.We selected stroke patients diagnosed in the Department of Neurology of Shandong Provincial Hospital from January2005to June2012as subjects for the survey, a total of5218cases including ischemic stroke and hemorrhagic stroke,2.207cases of the above mentioned stroke patients screened met the standard, according to diagnostic criteria for ARF.3.We collected the clinical data of all cases included in the study, including: general information, history of present illness, past history, imaging studies, complications, renal failure risk factors, renal failure clinical symptoms and signs, laboratory test results, treatment measures, outcome. The retrospective study was used to analyze and summarize the clinical features. 4. All data were statistically analyzed using the statistical package SPSS18.0version, the measurement data between the two groups using t test; data calculating between the two groups using chi-square test; P<0.05being statistically significant.Results:1.Among the ARF patients as subjects in this study, with an average age of (72.3±10.3) years old, subjects of65-75years old and80-85years old were two peaks of incidence. Trouble with ARF or without ARF after Stroke made a significant difference in the age of patients(P <0.05).2. Among the total of5218cases of stroke patients in this study.,the male with ARF were92cases (44.44%), female with ARF being115cases (55.56%); while men cover2509cases (50.07%), with women without ARF2502cases (49.93%). Which indicated no significant difference in their gender whether patients suffer from ARF or not after stroke (P>0.05).3.Cases of ischemic stroke number is4514,cases of hemorrhagic stroke cases is704among whom171cases had occurrence of ischemic stroke with ARF,36cases of hemorrhagic stroke with ARF. Different types of stroke patients after stroke showed a significant difference in incidence of ARF (P<0.05).4.Stroke section made no significant difference in different types of patients with ARF after stroke.Different types of stroke in patients with ARF has much to do with cortex lesions area (P <0.05).Different types of stroke in patients with ARF has no significant correlation with their blood supply obstacles site (P>0.05). Lacunar infarction patients with ARF were26cases (12.56%); atherosclerotic cerebral infarction were complicated with ARF patients,55(26.57%).5.ARF in patients with previous history of hypertension patients were131cases (63.29%), ARF patients with a history of diabetes57cases (27.54%), indicating that the post-stroke patients with ARF and non-ARF patients were significantly different. Different type of stroke in patients had significant differences (P<0.05). patients of ARF with previous history of coronary heart disease were58cases (28.02%), patients of ARF with a history of atrial fibrillation53(25.60%), among whom, no significant difference was shown in post-stroke patients with ARF and non-ARF patients. Namely,different type of stroke in patients had no significant difference (P>0.05). Among patients with ARF there were57cases of former smokers (27.54%),33cases previously drinking (15.95%), Therefore there was no significant difference in post-stroke patients with ARF and non-ARF patients (P>0.05). Smoking rates made a significant difference in different types of stroke (P<0.05), while alcohol ratio was of no significant difference.in different types of stroke in patients (P>0.05).6.Patients with ARF after stroke are more conscious persons,the rate of disturbance of consciousness was40.58%.Ischemic stroke patients are prone to lethargy.Level of consciousness in hemorrhagic stroke patients is more serious,and prone to coma.7. Blood pressure (SBP, DBP) in patients with hemorrhagic stroke was significantly higher than that in patients with ischemic stroke (P<0.05).The average of triglycerides in post-stroke patients with ARF was (1.47±0.53) mmol/L, the average of total cholesterol in stroke patients with ARF being (5.66±2.35) mmol/L, indicating no significant difference in stroke patients with ARF and non-ARF,and no significant difference in patients with hemorrhagic stroke and ischemic stroke patients.(P>0.05) The avarage level of blood glucose in patients with ARF after stroke was (8.34±3.24) mg/dl, indicating the average blood glucose levels of patients with ischemic stroke were significantly higher that in patients with hemorrhagic stroke (P<0.05). BUN of stroke patients with ARF ranged from (13.85±5.33) mmol/L, with an average SCr of (163.3±28.91) umol/L, in ARF patients after stroke.The average BUN/Cr was (113.5±38.64) in stroke patients with ARF while stroke patients with ARF had a urine specific gravity average (1.02±0.005). The average of urinary protein in patients with ARF after stroke was (0.54±0.22)g, indicating no significant difference in patients with hemorrhagic stroke compared with patients with ischemic stroke(P>0.05).ARF patients after stroke had the osmotic average (298.2±20.41) mOsm/L. Namely, the osmotic pressure of patients with hemorrhagic stroke was significantly higher than that in patients with ischemic stroke (P<0.05).The calcium average is of (2.23±0.62) mmol/L in ARF post-stroke patients,patients with ARF after stroke averaging (3.89±0.81) mmol/L in serum potassium. The average serum sodium of post-stroke patients with ARF being (142.1±5.92) mmol/L, serum chloride average was (101.4±2.71) mmol/L ARF in patients after stroke. Electrolyte levels change significantly in different type of stroke (P<0.05).8.From the first day to the onset of ARF the total amount of20%mannitol had been applied to patients is (358.5±72.36) g, while patients with hemorrhagic stroke had a much higher dosage of mannitol than patients with ischemic stroke (P<0.05). For patients hospitalised after stroke, a total of39cases (18.85%) patients with ARF, had urine catheterization.The first5days of daily fluid when ARF occurred, there was a total of (3288±725.4)g/d、(2924±691.1)g/d in and out, indicating no significant difference to patients with ischemic and hemorrhagic states (P>0.05).9. A total of75cases (36.23%) of stroke patients with ARF died within30days after onset, which was significantly higher than stroke patients without ARF (P<0.05).111cases (53.62%) of ARF patients after onset of stroke had their state improved,which was significantly lower than with non-ARF patients (P<0.05). Namely,there was no significant difference between ischemic and hemorrhagic patients who died within in30days (P>0.05).Conclusion:The main factors and clinical features of acute stroke patients with ARF found in the current study are as follows:1) age factor.2) Hypertension, DM are risk factors for the development of ARF.3) Hemorrhagic stroke is more prone to have the occurrence of ARF compared with ischemic stroke.4) Hemorrhagic stroke which belonged to subcortical lesions is likely to cause ARF.5) Consciousness impairment in patients is prone to renal hypofusion inducing ARF.6) Excessive use of mannitol will promote the occurrence of ARF, balance disorders of water and electrolyte.7) ARF incidence adds to the risk of death with stroke.

急性腦卒中患者并發(fā)急性腎功能衰竭的臨床特點回顧性分析

中文摘要6-10英文摘要10-13符號說明14-15前言15-18臨床資料和研究方法18-20結(jié)果20-28討論28-41結(jié)論41-43附圖表43-52參考文獻52-55綜述55-61    參考文獻59-61致謝61-62學(xué)位論文評閱及答辯情況表62

  本文關(guān)鍵詞：急性腦卒中患者并發(fā)急性腎功能衰竭的臨床特點回顧性分析，由筆耕文化傳播整理發(fā)布。