老年多器官衰竭的肾脏问题

摘要

Acute kidney injury (AKI) is, generally, a common problem in the elderly with multiple organ failure (MOFE) and what’s more, it significantly contributes to the poor outcome in these patients. Therefore, it is of great importance to protect kidney in the diagnosis and treatment of MOFE. In recent years, significant progress has been made on the role of AKI in the etiology and pathophysiology of MOFE, “normotensive ischemic acute renal failure” and “transrenal perfusion pressure” for example. These increasing new concepts are of meaningful value in the understanding of AKI in the elderly. Some new biomarkers make it possible to the early diagnosis of AKI in the MOFE in clinical practice. Multiple strategies may greatly improve the outcomes in the MOFE patients with AKI, including timely consultation with nephrologist and various managements to protect renal functions during the treatment of MOFE, such as drug dose and intervals based on renal function, suitable vasoactive drug to increase blood pressure, and rational adjustment of mechanical ventilation parameters.%老年多器官衰竭（MOFE）常伴有急性肾损伤（AKI），预后极差。肾脏保护是MOFE临床诊治中的一个重要问题。近年，AKI在MOFE中的发病原因和病理生理机制有不少新进展，如“血压正常的AKI”和“跨肾灌注压”等概念对理解老年AKI的发生具有重要意义。一些新的生物标志物在临床上的应用使AKI的早期诊断成为可能。肾脏专科医师的及时会诊，以及在MOFE治疗过程中对肾功能保护的各种方法，如按照肾功能水平计算用药剂量和间隔时间、采用合适的血管活性药物提升血压、调整合理的机械通气参数等，均可以改善伴有AKI的MOFE患者的预后。